Mohave county Gemstoners
PO Box 3992, Kingman, Az 86402
www.gemstoners.org
Membership application
Dues for full year:
Single: $15 If joining after July 1st: $7.50 Couple: $20 If joining after July 1st: $10
Family: $25 If joining after July 1st: $12.50 There is an $8-Pin or $9-Magnetic fee for Membership
Badges which are to be worn at all Club functions.
Name: ______________________________________________ Birth Month: ______________
Name: _______________________________________________ Birth Month: ______________
Additional names & Birth months: ___________________________________________________________________
Address: __________________________________________________________________________________________
Phone: __________________________ Cell: ______________________ E-mail: _______________________________
As a Member you will be expected to participate and support Club activities. There are many opportunities that require
help in order to keep the Club functioning smoothly. Field Trips, Club Promotions, various committees, Officers, our
Annual Rock & Gem Show. Volunteering is a fun way to get to know other Members and get the most out of your
Membership in our Club. By signing you are agreeing to our Constitution and By-Laws and Standing Rules.
Signature(s)________________________________________________________________________________________________
Club Use: No Partial Payments, Please.
Type of Membership: ______ Single _____Couple _____Family Dues: _____________
Number of Badges: ______ Fee: _______________
Date: ____________ Paid to: _______________________________ Total: _____________
Renewal:
Date: _____________ Amt Paid _________________ For Year: ___________ Paid to: ________________________________
Date: _____________ Amt Due: _________________ For Year: ___________ Paid to: ________________________________
Date: _____________ Amt Due: _________________ For Year: ___________ Paid to: _______________________________
Date: _____________ Amt Due: _________________ For Year: ___________ Paid to: _______________________________
Date: _____________ Amt Due: _________________ For Year: ___________ Paid to: _______________________________
Date: _____________ Amt Due: _________________ For Year: ___________ Paid to: _______________________________
Date: _____________ Amt Due: _________________ For Year: ___________ Paid to: _______________________________
Date: _____________ Amt Due: _________________ For Year: ___________ Paid to: _______________________________
Date: _____________ Amt Due: _________________ For Year: ___________ Paid to: _______________________________
Date: _____________ Amt Due: _________________ For Year: ___________ Paid to: _______________________________
Updating or adding any information: __________________________________________________________________________
____________________________________________________________________________________________________________
