Note: You do not have to have a Google account to use this form.
Club Name *
Please enter the full name of the club. For example, Georgia Mineral Society, not GMS
Your answer
Your Name *
Your answer
Phone number *
Your answer
Mailing address *
This can be your club's mailing address or your personal address. This address will be used to mail the program.
Your answer
Number and title of the program you want *
Use the information from the program index is on this page. For example, D138-IDENTIFYING MINERALS for the DVD or V138 IDENTIFYING MINERALS for the VHS.
Your answer
Alternate 1
Number and title of an alternate program if the program you want is not available
Your answer
Alternate 2
Number and title of an alternate program if the program you want is not available
Your answer
Date the program is to be presented to your club
MM
/
DD
/
YYYY
Please return the program within 4 days after it has been presented at your club.
Return instructions are on the Slide/Video Program page