MEMBERSHIP INFORMATION AND DUES
North Jeffco Gem & Mineral Club

Please print out and fill in the following form and send it in (or bring it to our next meeting). If you are going to mail it, send it with a check (amount shown below) to the following address. Dues are currently $20/year for couples or families. $15/year for singles. Members with a permanent address living more than 100 miles from Arvada, Colorado can pay dues of only $15/year. Dues are subject to change without notice. Please make checks payable to "NORTH JEFFCO GEM AND MINERAL CLUB". (Birthdays only need to be day and month.)

  Martin Hannu
  Membership Chairman, NJG&M Club
  7911 Bradburn Blvd.
  Westminster, CO 80030

If you have membership questions, please e-mail Martin at icd55mph@qwest.net

TYPE OF MEMBERSHIP (please circle one):   Family     Single     100+ miles

FIRST NAME______________________________ LAST NAME_______________________________

SPOUSE__________________________ PHONE (HOME)_______________ (WORK)_____________

ADDRESS__________________________________________________________________________

CITY_________________________________ STATE___________________ ZIP_______________

E-MAIL ADDRESS______________________________ FAX NUMBER__________________________

YOUR BIRTHDAY__________________________ SPOUSE'S BIRTHDAY_______________________

CHILDREN'S NAMES & BIRTHDAYS_____________________________________________________

_________________________________________________________________________________

OTHER MINERAL CLUBS YOU BELONG TO______________________________________________

_________________________________________________________________________________


LEAD A FIELD TRIP?  If yes, where to?____________________________________________

PRESENT A PROGRAM?  If yes, what is the topic?___________________________________

SERVE AS AN OFFICER?  Y/N      SERVE AS A COMMITTEE CHAIRPERSON?  Y/N


 Website form updated July 19, 2007