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MSSC Annual Membership Application
Please complete the form:
NEW
and
RENEWING
members
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* Indicates required question
First name:
*
Your answer
Last name:
*
Your answer
Address
Please enter your address in the fields below. Then choose to include or exclude your address in the roster by clicking yes or no.
Street:
*
Your answer
City:
*
Your answer
State
*
Your answer
ZIP Code +4
*
Your answer
Address in roster?
*
Yes
No
Required
Cell Phone: (if you don't have one, please write none)
*
Your answer
Cell phone number in roster?
*
Yes
No
Required
Home Phone: (if you don't have one, please write none)
*
Your answer
Home phone number in roster?
*
Yes
No
Required
Email:
*
Your answer
Email in roster?
*
Yes
No
Required
Additional name(s) and relationship if this is a family membership:
Your answer
Our annual Roster will be sent via email and will include only the information you approve above. The Roster is ONLY for the personal use of our members.
NOTE: THE BULLETIN IS NOW DISTRIBUTED VIA EMAIL
If you wish to receive the Bulletin in a printed, black-and-white format via the US post office, there is an additional annual charge of $35 to cover the printing and postage.
Membership Dues for One Year:
*If you pay by PayPal there is an additional $2 fee per item.
$30 Individual ($10 for CFMS and $20 for MSSC)
$40 Family ($20 for CFMS and $20 for MSSC)
$35 USPS delivered, paper bulletin
Payment Information
*
please check how you will pay your dues.
Mailed check
PayPal
Required
Pro-Rated Membership starting on July 1
Notice: CFMS does not pro-rate dues; MSSC does pro-rate annual dues. * If you pay by PayPal there is an additional $2 fee.
$20.00 Individual ($10 to CFMS and $10 to MSSC)
$30.00 Family ($20 to CFMS and $10 to MSSC)
Donations
$100 Platinum
other
Pay online with PayPal (you will see the link after you submit this form, or make checks payable to MSSC and mail them to: MSSC, 13781 Alderwood Lane #22J, Seal Beach, CA 90740-3993
* If you pay by PayPal there is an additional $2 fee.
Questions: Contact Carolyn Seitz (MSSC Treasurer) at:
treasurer@mineralsocal.org
Form Rev. 1/23
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