Mineral
Club of
Membership Application Form
Please note: Providing of
information requested below is optional and any details will be treated in
confidence if requested.
First Name: Surname:
Street:
Suburb: Town:
Profession:
Telephone Number (home) (work)
e-mail:
I am
particularly interested in:
Minerals and crystals YES
/ Not interested
Micro minerals YES
/ Not interested
Gemstones/material YES
/ Not interested
Lapidary/Jewelry making YES
/ Not interested
Paleontology (fossils, petrified flora &
fauna) YES
/ Not interested
Geology (general) YES
/ Not interested
Field trips YES
/ Not interested
Other (please specify)
I
would like to know or learn more about:
Cutting/polishing/tumbling of gem
material/stones YES
/ Not interested
Silver smithing/Jewelry
making YES
/ Not interested
How and where to collect (please specify)
Other (please specify)
I
don’t mind to:
Occasionally contribute to the club news letter YES /
Not interested
Perhaps be an occasional speaker YES
/ Not interested
Serve on the club committee (if offered) YES
/ Not interested
Offer tuition on (please specify)
I hereby agree that my membership will be valid
and current by having paid the due annual subscription fee.
Date: Signature:
Office
use only:
Membership
approved: Date
Please send to: Mineral
Club of Hutt Valley and Wellington
Or e-mail to: mc_hv_wgtn@hotmail.com