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THE GEORGIA MINERAL SOCIETY, INC.
P.O. Box 15011, Atlanta, GA.  30333-5011
MEMBERSHIP APPLICATION
We are a NON-PROFIT EDUCATIONAL organization that thrives with your VOLUNTEER HELP!

YOUR NAME:  ___________________________________________________________________________________________________________

E-MAIL ADDRESS: _____________________________________@________________________________________________________________

SPOUSE'SNAME:  _______________________________________________________________________________________________________

E-MAIL ADDRESS: _____________________________________@________________________________________________________________

CHILDREN’S NAMES & AGES (Residing at home) _____________________________________________________________________________

________________________________________________________________________________________________________________________

ADDRESS:   _____________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

CITY: _________________________________________________________      STATE: ___________________       ZIP: _____________________

      HOME PHONE:(           )___________________________                OFFICE PHONE:(            )_______________________________

      OTHER:  (           )  _________________________    INTERNET ADDRESS: http://www.____________________________________________

OCCUPATIONS, HOBBIES, INTERESTS:  ____________________________________________________________________________________

________________________________________________________________________________________________________________________
SPECIAL INTEREST GROUPS AT GMS: (check all that apply)

0  Mineral Section                           0  Micro-mount Section                                 0  Fossil Section
  0  Junior Section          0  Gem Section             0  Electronic Newsletter
          DUES FOR NEW MEMBERS (Single, Couples, Family) are $25.00 per Society year.  ($20.00 + $5.00 initial processing fee)  
          RENEWAL DUES ARE $20.00 (due 12 months from the date of joining)
          REINSTATEMENT DUES for expired memberships are $25.00 ($20.00 + $5.00 reinstatement fee).
          FAMILY MEMBERSHIPS ARE FOR THE IMMEDIATE FAMILY INCLUDING CHILDREN RESIDING WITH PARENTS.
          CHILDREN 16 YEARS OF AGE AND YOUNGER ARE CONSIDERED JUNIOR MEMBERS.
    PLEASE MAKE CHECKS PAYABLE TO THE GEORGIA MINERAL SOCIETY, INC.
    Mail to: P.O. BOX 15011, ATLANTA, GA.  30333-5011

    For official use only: 
    DATE PAID:_____________________ AMOUNT PAID:_$____________      CHECK #: ___________    CASH:_$_________
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