Gem & Mineral Club
Mineralogical Society of Northeastern Pennsylvania
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Gem & Mineral Show

 

February Meeting
Our February meeting will be on Sunday February 24
th

Our Next Newsletter will be posted once things start rolling again!

 


Membership Application

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...

*Name____________________________________________________________________________

*Mailing Address_____________________________________________________________

*City____________________________________________*State________*Zip Code________

Phone_____________________________________Cell_____________________(optional)

*E-mail_________________________________________________________________

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.

Signature_______________________________________________________________Date__________