Membership

 _____ Renewal _____ New Member

_____ Single ($15)
_____ *Family ($20)*Family membership includes two adults and all children under the age of 18
Names of Adults: _______________________________________________________________

Number of Children under 18: _________
Mailing Address: _____________________________________________________________
Telephone Number: _________________________________________
Email Address: ____________________________________________
Newsletter Preference (Check one): _____via email or _____ via USPS
NOTE: USPS option costs an additional $20 to cover postage and printing.

Please help by answering the following survey questions:
 What are your specific mineral interests? (exp: micro-mounts, fossils, lapidary, etc.)

 What are your reasons for joining the club?

 What speaker topics are you interested in?

 Would you be willing to join the executive board?

$_________ Dues - Single ($15) or *Family ($20)*
$_________ $20 for Newsletter via USPS per address per year
$_________ Total
Make checks payable to OCM&G Assoc.
Please print and bring the completed application and payment to a club meeting, or mail to:
Dennis Gross
178 N. Main Street
Bryant Pond, Me 04219