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Membership Application
Mail this form with check to:
KYANA Geological Society
P.O. Box 5746
Louisville, KY 40255
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
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( ) fossils
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( ) study groups
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( ) social functions
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| ( ) lapidary arts |
( ) junior rockhounds |
( ) teach/presentations |
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( ) gems
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( ) show committee
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( ) specimen auctions
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| ( ) 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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