Download SRLS Application Form

RETURN TO
Gil Benoit, Treasurer
Sudbury Rock & Lapidary Society
4092 Lillian Avenue
Hanmer, ON P3P 1A2
Tel. (705) 969-3130
SUDBURY ROCK & LAPIDARY SOCIETY
MEMBERSHIP APPLICATION
NAME: __________________________________
AGE: __________________
ADDRESS: Street: ________________________
Apt.: __________________
City: __________________________
Prov.: _________________
Postal Code: __________________
TELEPHONE NO.: Home: ( ____ ) ____ - _______
Work: ( ____ ) ____ - _______
FAX NO: ( ____ ) ____ - _______
E-MAIL: ______________________ @ _____________________________
FAMILY MEMBERSHIP: Yes: __________
FAMILY MEMBERS:
AREAS OF INTEREST:
No: ___________
____________________
____________________
____________________
____________________
Gems _____ Minerals _____ Rocks _____ Fossils _____
Lapidary _____ Micromounts ______ Silversmithing _____
Organization _____ Field Trips _____
SIGNATURE: _____________________________
DATE: ______________ 20____
The SUDBURY ROCK & LAPIDARY SOCIETY is a non-profit organization formed in 1984, and
incorporated in 1991, to promote geoscience as a recreation. Membership is $10.00 per year (individual
st
st
or family) which covers the calendar year (January 1 to December 31 ), or any part of the year.
Members receive a monthly newsletter (Nickel Basin Rockhound), lapidary equipment use upon
completion of the required training course, and voting and library privileges. Central Canadian Federation
of Mineralogical Societies (CCFMS) dues are included as part of the SOCIETY dues.
For Official Use Only:
RECEIVED BY:_________________
DATE: ______________ AMOUNT: _______