Cache Rock & Gem Club Primary Contact: Gary Warren Phone: 435-720-1775 E-Mail:email@example.com Location: Summit Elementary School, 80 W Main Street, Smithfield, Utah 84335 (In the back on the east side of the library)
Membership Application/Renewal Form
Please fill out this form in its entirety, even if you are a renewing member and none of your contact information has changed.
Membership Information Application Year: ________ (The year you are paying dues for) Please Choose One: _____ New Membership____ Renewal Membership Please Choose One: _____ Individual ($15.00) _____ Family ($20.00)
Personal Information First Name: ___________________________________ Last Name: ______________________________________ If this is a family membership, list spouse and any children under age 18:_______________________ _________________________________________________________________________________________________
Mailing Address:________________________________________________________________________________ City: _________________________________________ State: ____________________ Zip: ___________________ Phone: _______________Cell Phone: ________________Email Address: _______________________________ (Note: Club communication is via email.)
Optional Information: Special Interests (optional):______________________________________________________________________ Would you like to volunteer for:_____ Juniors _____ Club Meetings _____ Field Trips ______ Newsletter ______ Help with Annual Show Other
Payment Information: Please Choose One: ______ Paid by Cash ______ Paid by Check (Payable to Cache Rock & Gem Club) Check #: _______________ Mail to: Cache Rock and Gem Club, 53 N 200 W Brigham City, Utah 84302