CHE-HANNA ROCK & MINERAL CLUB MEMBERSHIP APPLICATION

NEW ________ RENEWAL _________ HONORARY ________

MAKE CHECKS PAYABLE TO CHE-HANNA ROCK & MINERAL CLUB

_____ INDIVIDUAL MEMBERSHIP ………………………….. $ 8.00

_____ FAMILY MEMBERSHIP ……………………….……… $12.00
( INCLUDES PARENTS AND ALL CHILDREN UNDER 16 YEARS OLD )

MEMBERSHIP INCLUDES SUBSCRIPTION TO THE SHIN-SKINNER NEWSLETTER

VIA US MAIL ______         E-MAIL ______         BOTH ______

NAME ___________________________________Birthday (m/d) ______/_______

ADRESS ____________________________________________________________

TOWN ____________________________STATE ________  ZIP CODE _________

PHONE _______________________   E-MAIL _____________________________

SPOUSE NAME _______________  Birth (m/d) ___/___ Anniversary (m/d) ___/___

CHILD NAME _____________________________________ Birth (m/d) ____/____

CHILD NAME _____________________________________ Birth (m/d) ____/____

CHILD NAME _____________________________________ Birth (m/d) ____/____

CHILD NAME _____________________________________ Birth (m/d) ____/____

WHAT AREAS OF THE ROCK AND MINERAL HOBBY ARE OF INTEREST TO YOU AS A MEMBER IN THIS CLUB?  PLEASE LIST ALL INTERESTES AND ALSO ANY ACTIVITIES OF THE CLUB YOU ARE WILLING TO HELP WITH.

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RENEWAL DUES ARE DUE BY JANUARY 1st EACH YEAR.  IF NOT PAID BY JANUARY 1st, MEMBERSHIP WILL TERMINATE.  REJOINING LATER WILL BE CONSIDERED A NEW MEMBERSHIP REQUIRING A WAITING PERIOD OF SIX MONTHS TO RECEIVE DISCOUNTS ON TRIPS, CHRISTMAS DINNER, WORKSHOP PRIVILEGES  ETC. PRINT OUT THIS FORM, FILL IT OUT, AND WITH A CHECK MADE OUT TO:

CHE-HANNA ROCK & MINERAL CLUB, Inc. - MAIL TO:
TRISH BENISH --- 9516 N. ROME RD. --- ATHENS, PA 18810