I, herewith, apply for membership in The Mineralogical Society of Northeastern Pennsylvania
(CLUB). I understand that membership dues are payable annually, with the membership year
running from January 1st to December 31st
SENIOR MEMBERSHIP $10.00 PER YEAR (18 yrs. or older)
FAMILY MEMBERSHIP $15.00 PER YEAR (per family)
Enclosed $_________________ for dues for 2015
Make checks payable to MSNEPA and mail to:
MSNEPA c/o Linda Williams 615 East Grant St. Olyphant PA 18447
PLEASE PRINT THE FOLLOWING INFORMATION CLEARLY...
For a family membership, please provide names of the other family members
(Please include ages for children under 18 only ).
If more than 4 members please add on back of form.
1) _______________________________age______ 3) ______________________________age_______
2) _______________________________age ______4) ___________________________age__________
Please note: All members taking field trips sponsored by the CLUB, do so at their own risk.