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Membership Application
Mail this form with check to:
KYANA Geological Society
P.O. Box 32561
Louisville, KY 40232-2561
Make check payable to: KYANA Geological Society
please print clearly.
name _______________________________________________________________
address ____________________________________________________________
city ________________________ state
___________ zip code ___________
e-mail ______________________________________________________________
phone: Home (____) ____________ Business (____) ___________date _______
type of membership desired (due Jan 1st):
( ) new ( ) renewal
( ) individual ($15.00) (
) student ($10.00) ( ) family
($20.00, list names):
____________________________________________________________________________________
dues cover the period of Jan-Dec
& include
both KYANA & federation dues.
please check all areas that interest you or your
family:
| ( ) mineralogy |
( ) field
trips |
( ) serve on a
committee |
( ) fossils |
( ) study groups |
( ) social functions |
| ( ) lapidary
arts |
( ) junior
rockhounds |
( ) teach/presentations |
( ) gems |
( ) show committee |
(
) specimen auctions |
| ( ) crystals |
( ) swap
sessions |
(
) other _______________ |
| ( ) general
geology |
(
) exhibiting |
(
) other _______________ |
Please let us know if you have any skills that you
would like to share with the club
(leadership, accounting, computer skills, marketing, editing, etc.):
___________________________________________________________
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