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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: _______