Membership Form

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Membership Form

White River Rock Gem and Mineral Club Registration

General Meeting:

1st Monday each Month

7:00pm

St. James Lutheran Church

8945 Stebbins St.

Montague Mi

Membership Type *

Please pay

Individual -$20.00

Family- $25.00 (Includes parent/guardian, spouse, and all unmarried children under the age of 17 and living at home)

Today's date *

YYYY

Last Name *

First *

Spouse First Name (If family membership)

Address *

Street Address, City, State, Zip

Phone # *

Spouse Phone #

Email (Primary Newsletter Email) *

Email (Spouse)

If this is a family membership, how many children will be joining?

Clear selection

If this is a family membership, please list participating children('s) name(s) and Birthyear(s).

Ex: Jet Paul 2019, Cy Paul 2013

What are your main interests in joining our club?

Archaeology

Beading

Faceting

Field Trips

Fossils

Geology

Lapidary

Metal Craft

Minerals

Polishing

Rock Collecting

Wire Wrap

Youth Activites

WRRGMC PRIVACY POLICY: For purposes of planning field trips and other WRRGMC Social activities, the club will annually distribute a listing of member names, addresses, telephone numbers and email addresses to all club members. The WRRGMC officers will never knowingly distribute your address information to any other group or organization. *

I acknowledge

IMPORTANT NOTE: We must have a SIGNED copy of your application/renewal form on file.As a condition of membership, and in consideration of any mineral collecting, use of facilities , equipment and other educational opportunities available to me as a club member, I hereby agree to hold the Club and its officers, Directors, committee members and agents harmless, and to indemnify them against any loss and claims arising from me or my family’s participation in Club activities: *

I acknowledge

Term of Membership and Dues. WRRGMC memberships run January – December.NEW members joining after October 1st will have their dues credited through the end of the following year. Membership Renewals must be renewed by December 31st to be in good standing. *

I acknowledge

Adult Signature *

(please type name below, this counts as your official signature)

I acknowledge that the above counts as my official signature. *

I acknowledge

Submit

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