EVERETT ROCK & GEM CLUB Application for membership Adult_________________________________________Birthday_______________                                                                                                          (month) (day) Occupation________________________________Email______________________ Adult_________________________________________Birthday_______________                                                                                                          (month) (day) Occupation________________________________Email______________________ Telephone___________________________Wedding Anniversary_______________                                                                                                            (month) (day) Street____________________________City__________State______Zip_________ Youth Members 1.______________________________Birthday________________                                                                                                          (month) (day)                          2.______________________________Birthday________________                                                                                                           (month) (day)                          3.______________________________Birthday________________                                                                                                           (month) (day) As a member of the Everett Rock & Gem Club, I agree to abide by the rules of the American Federation of Mineralogical Societies (AFMS) Code of Ethics. As a member of the Everett Rock & Gem Club, I agree to abide by the Constitution and By-Laws of the Everett Rock & Gem Club. I agree that the Everett Rock & Gem Club or its members shall not be held liable for any accident, injury, or loss to me or my family members while engaged in Everett Rock & Gem Club activities. Annual dues: $10/Individual, $15/Couple, $3/Juniors (under 18 & with adult member) Skills and Interest Survey:                                  Enjoy doing/Want to learn Tumbling:                    _________ ___________ Cabochons:                  _________ ___________ Faceting:                      _________ ___________ Carving:                        _________ ___________ Jewelry Making:             _________ ___________ Silver/Gold Smithing:    _________ ___________ Mineral Collecting:        _________ ___________ Fossil Collecting:            _________ ___________ Club Organization Work: _________ ___________ Work with Juniors:           _________ ___________ Skills I have:_______________________________________ Rock Equipment I have:______________________________ Signature:____________________Signature:____________________Date:_______ Everett Rock & Gem Club, PO Box 1615, Everett, WA 98206 Web Site: http://www.everettrockclub.com