TAR HEEL GEM & MINERAL CLUB, INC
Membership Application
2008
Date _____________ ____Renewal ___New Membership
Applicant Name _______________________________ ___________________
birth month
Additional Names ________________ ____________birth month
________________ ____________birth month
________________ ____________birth month
Address ______________________________________________________________
Street City State Zip
Telephone (_____)___________
E-Mail Address ______________________________________
Would you like to receive the newsletter via email rather than mail? YES NO
Would you like to be a volunteer in the annual club gem & mineral show? YES NO
Will you be an active participant on field trips and like to be notified about them? YES NO
Please check your interests –
Applicant additional members
Mineral collecting ________ ________ ______ ______
Fossil collecting ________ ________ ______ ______
Gold smithing ________ ________ ______ ______
Silver smithing ________ ________ ______ ______
Wire wrapping ________ ________ ______ ______
Cabbing ________ ________ ______ ______
Faceting ________ ________ ______ ______
Jewelry making ________ ________ ______ ______
Other ________ ________ ________ ______ ______
TAR HEEL GEM & MINERAL CLUB, INC.
10609 CHELSEA DR. RALEIGH, NC 27603
Annual dues are $15.00 for the first member and
$5.00 for each additional family member over the age of 17.