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Membership Application: To become a member, just print this, fill it out, and mail it along with a check for the right amount to: 
Beehive Rock & Gem Club
P.O. Box 1011
Ogden, Utah 84403
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Membership Application

Name _____________________                Spouse______________________

Birth Month & Day____________                Birth Month & Day______________


Address_____________________________________

City_____________________        State_____________         Zip______________

Phone___________________        Email: _____________________


             Children                                          Birth Month & Day

1.___________________                        ____________________

2.___________________                        ____________________

3.___________________                        ____________________

4.___________________                        ____________________
       
Annual Dues----Payable on October 1 each year for the next calendar year
Single Membership                       $11.00
Couple/Family Membership         $16.00
Junior Membership                        $5.00

Junior Members less than 16 years of age must be supervised by an adult relative or designated adult club member

Club Name Tags----May be ordered for a fee of $6.50 each
Please print clearly on the lines below the name required on each tag

1.___________________________                3.__________________________

2.___________________________                4.__________________________



Signed__________________________                Date________________________

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