This is your club membership form for 2009. Please include all the names to be included in your Household Membership. This information is required by the Rocky Mountain Federation of Mineralogical Societies, RMFMS, for insurance and dues purposes.

Annual dues are $20.00 per household. Please complete all the information below.

New members joining in July or August pay dues of $10.00 for the rest of the year. If you join September through December you can pay dues of $10.00 for the rest of the current year, OR pay $20.00 in dues which will pay you through December of the following year.

All memberships expire Dec. 31st. Dues can be turned in at the monthly meeting or mailed to:

Last Name _________________________________ Date _____________

Senior Member Names 1. __________________________________________

2. __________________________________________

Junior Member Names 1. _________________________________age______

2. _________________________________age______

3. _________________________________age______

4. _________________________________age ______

New Member or Renewal ? _________________

Would you like your name and phone number listed on the Club Roster ? __________

Mailing Address: ________________________________________ Apt. # ______

City: ____________________________ State: ________ Zip + 4: ____________

Phone: (_______) ______ - ___________

Email Address: ______________________________________________________

Payment: $ _____________ Date Received: ___________ Date of Check: ________

Ck #: _________ , Cash or Money Order #______________________