2017 MEMBERSHIP APPLICATION
Lake George Gem & Mineral Club
Box 171, Lake George, Colorado 80827
www.LGGMclub.org
Date:
_______/_______/2017
Name
____________________________________________________________________________
Address ________________________________City __________________State ______ Zip _________
Telephone (
) ______ - ____________ E-mail _________________________________________
(email Required to receive Newsletter and Field Trip info.)
Names/Ages of family members (if family membership): ________________________________________
____________________________________________________________________________________
* all Applications for Renewals & New Memberships must be received btwn. Jan 1 & Mar 31.
~ Existing Member renewals Not received by Mar. 31 will be Removed from the Roster!
~ No new Applications will be accepted after Mar. 31). ~ Fees remain as follows :
_____ Individual (18 and over) …………………………………………………….. $15.00
_____ Family (includes dependents under age 18) ….…………………..………. $25.00
√ I agree to Abide by Club Constitution, By-Laws, and Rules regarding Field Trips & Club Claim visits:
√ Signed ___________________________________________________ Date: _______/_______/________
I am or have previously been a member of Lake George Gem & Mineral Club. Yes _____ No ______
My interest areas include (check all that apply): Minerals ______ Fossils______ Lapidary ________
Micromounts _____ Colorado Geology _____ Pebble Pups (ages 7-17) ______ Mining History ______
Crystallography _____ Other (be specific): _________________________________________________
I am willing to give a talk/presentation to [the Club] or [Pebble Pups] on ______________________ (topic)
and/or Lead Field Trip(s) to ______________________________________________________________
I am willing to participate/help in the following ways (can choose more than one): Club Officer ________
News Writer-Contributor _______ Annual Show Committee ________ Nominating Committee _________
Winter Programs ______ Field Trips _______ Membership Coordinator _______ Scholarship/Education
Committee _________ Pebble Pups ________ Other (be specific): _____________________________
Questions about the Club or Activities?
Please visit the website or contact a Club Officer.
Updated 1/4/2017