home

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.):
___________________________________________________________

home