JOINING FORM

Whangarei Rock & Gemstone Club Inc
Postal Address: C/o Shirley Gates, 787 State Highway 14, RD 9, Whangarei 0179


Application to Join the Club

Please print this page, complete all sections of this form, sign it and attach your first subscription payment. For the family rate, please complete the names for each person and all people in the family 18 years or older are to sign.

Annual Subscriptions
Subscriptions are due for renewal on May 31 each year.


Joining Fee $5

Junior $5  (16 or younger, or school students)
Associate $16
Single $25
Family $35  (husband, wife, and children who are at school)

Name(s):

Postal Address:

Phone:

Email (if applicable):

 I/we apply to join the Whangarei Rock & Gemstone Club Inc, and agree to abide by the Constitution and Rules of the Club. I/we hereby agree that my/our membership, if accepted, will only be valid and current by having paid in full the current annual subscription fee.

Signature(s):

Date:

Office Use Only

Membership accepted by:                                                       Date:
Details passed to Treasurer (Date):
Details passed to Newsletter Editor (Date):