WELCOME TO THE HUACHUCA MINERAL & GEM CLUB

MEMBERSHIP APPLICATION

HUACHUCA MINERAL AND GEM CLUB
P.O. BOX 1596
SIERRA VISTA, AZ 85636

The regular monthly meeting is held on the third Wednesday of each month, except July & December. 
Meetings are held at Cochise Community College
901 N. Colombo Ave
Horace Steele Conference Room
Sierra Vista at 7:00pm


INDIVIDUAL _______________ FAMILY ________________

PLEASE PRINT:

LAST NAME ___________________  FIRST NAME _________________ MI ____ BIRTHDAY ____/_______

ADDRESS______________________ CITY _________________________ STATE _________ ZIP _________

PHONE NO _____- _____- ___________  OCCUPATION ___________________________________________

E-MAIL ADDRESS (TO RECEIVE NEWSLETTER) ________________________________________________

MEMBERSHIP DUES:  The annual dues for an individual 18 years and over: $20.00 (Jan 1st - Dec 31st)
Family membership is $30.00 
Joining in the months of Oct, Nov & Dec. Your dues are paid until Dec 31st of the following year.
Dues are payable with the submission of this application.

Please indicate the area/areas of the Club's activities you are interested in.
Check all that apply:
LAPIDARY ______ FIELD TRIPS ______ FOSSILS ______ SILVER SMITHING ______ FACETING ______
MINERALOGY ______ GEOLOGY ______ GOLD SMITHING ______
OTHER _____________________________________________________________________________________
     
             _____________________________________________________________________________________

 On which committees would you be willing to serve? ( No experience needed)

CHECK ALL THAT APPLY:  FIELD TRIPS ______ EDUCATIONAL ______ ANNUAL SHOW ______ MEMBERSHIP ______  HISTORICAL ______ PROGRAMS ______ SUNSHINE ______ SOCIAL ______ NEWSLETTER ______  WEB SITE ______ PUBLICITY ______


PAYMENT RECEIVED BY _____________________________________ DATE _______________________
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