Application form

ANTIOCH LAPIDARY CLUB

APPLICATION FOR MEMBERSHIP

Name ______________ Phone _

Address _______________________________________________________________________________

Spouse's Name, if married ___________________________

Anniversary – Month ________ Day ________

Date of birth – Month _ Day _

Are you or have you been a member of another lapidary club? _______ If so, name of club, where and when?

________________________ / _ / ____________

Do you have: Rock Collection _ Lapidary equipment

On a scale of 1 to 10, (10 being highest), rate your interest in the following:

Minerals _____ Micro mounts _____

Faceting _____ Lapidary _____

Tumbling _____ Beading _____

Crystals _____ Fossils _____

Carving _____ Metal Smithing _____

Geology _____ Field Trips _____

Other, please specify: ___________________________________

I am interested in supporting the club with:

Shop _____ Property _____

Show _____ Work Parties _____

Museum _____ Educational Presentations _____

Social _____ Juniors Program _____

*************************************************************************************

Membership Committee Report ___________________________________________________________

Date accepted _____________ Initiation fee paid _________ Dues paid __________

____________________________________ Treasurer's Signature

____________________________________ President's Signature

*****************


				*Antioch Lapidary Club* *Application form*



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		ANTIOCH LAPIDARY CLUB APPLICATION FOR MEMBERSHIP Name ____________________________________________ Phone _______________________________ Address _______________________________________________________________________________ Spouse's Name, if married ___________________________ Anniversary – Month ________ Day ________ Date of birth – Month _____ Day _____ Are you or have you been a member of another lapidary club? _______ If so, name of club, where and when? ____________________________________ / _________________________ / ________________________ Do you have: Rock Collection _____ Lapidary equipment ____ On a scale of 1 to 10, (10 being highest), rate your interest in the following: Minerals _____ Micro mounts _____ Faceting _____ Lapidary _____ Tumbling _____ Beading _____ Crystals _____ Fossils _____ Carving _____ Metal Smithing _____ Geology _____ Field Trips _____ Other, please specify: ___________________________________ I am interested in supporting the club with: Shop _____ Property _____ Show _____ Work Parties _____ Museum _____ Educational Presentations _____ Social _____ Juniors Program _____ *********************************************************************************** Membership Committee Report ___________________________________________________________ Date accepted _____________ Initiation fee paid _________ Dues paid __________ ____________________________________ Treasurer's Signature ____________________________________ President's Signature *************** Pin ______ By-Laws ______ Roster ______ Name Tag ______ Membership Card ______

Name ____________________________________________ Phone _______________________________

Date of birth – Month _____ Day _____

____________________________________ / _________________________ / ________________________

Do you have: Rock Collection _____ Lapidary equipment ____

Membership Committee Report ___________________________________________________________

Pin ______ By-Laws ______ Roster ______ Name Tag ______ Membership Card ______

Name ______________ Phone _

Date of birth – Month _ Day _

________________________ / _ / ____________

Do you have: Rock Collection _ Lapidary equipment

Pin By-Laws Roster Name Tag Membership Card __