Membership Application

Membership Application Form

Please mail your application to :
Gem & Mineral Club of Scarborough
10 Chichester Place ,Apt B1
Scarborough, On  M1T 1G5
Attention: membership

 Family Name;__________________________Given Name(s)__________________&__________________

Address;______________________________________________City;____________________________

Prov. __________________________  Postal Code______________________

Phone;__________________________E- Mail ;______________________________

 Note: Childrens’ names not required

Type of Membership;

{    } Individual          $15    {      }   Family       $20

{  } Renewal         {  } New Member                     Payment   { } Cheque                {  } Cash

If Family,how many members?  ______________

 How would you like your newsletter sent?    {     } E-Mail                            {              } Postal

Date Received _______________________________

>[ ] Collecting     [ ] Lapidary   [ ] Wireworks    [ ] Fossils