TAR HEEL GEM & MINERAL CLUB, INC
Membership Application
2012
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 $20.00 for the first member and
$5.00 for each additional family member over the age of 17.