Mineral Club of Hutt Valley and Wellington (Inc)

Membership Application Form

Please note: Providing of information requested below is optional and any details will be treated in confidence if requested.

First Name: Surname:

Street:

Suburb: Town:

Profession:

Telephone (home) (work) mobile:

e-mail:

Please send my monthly copy of Magma (club newsletter) by email.

I am particularly interested in:

Minerals and crystals YES / Not interested

Micro minerals YES / Not interested

Gemstones/material YES / Not interested

Lapidary/Jewelry making YES / Not interested

Paleontology (fossils, petrified flora & fauna) YES / Not interested

Geology (general) YES / Not interested

Field trips YES / Not interested

Junior Club YES / Not interested

Other (please specify)

I would like to know or learn more about:

Cutting/polishing/tumbling of gem material/stones YES / Not interested

Silver smithing/Jewelry making YES / Not interested

How and where to collect (please specify)

Other (please specify)

I don’t mind to:

Occasionally contribute to the club news letter YES / Not interested

Perhaps be an occasional speaker YES / Not interested

Serve on the club committee (if offered) YES / Not interested

Offer tuition on (please specify)

I hereby agree that my membership will be valid and current by having paid the due annual subscription fee.

Date: Signature:

Office use only:

Membership approved: Date

Please send to: Mineral Club of Hutt Valley and Wellington (inc.)

P.O Box 39064

Wellington Mail Centre

Lower Hutt 5045

Or e-mail to: mc_hv_wgtn@hotmail.com