Beehive Rock and Gem Club
Beehive Rock and Gem Club
Membership Application
Name:________________________________ Spouse:________________________________
Address:_____________________________________________________________________
City:__________________________ State:________________ Zip Code:_______________
Phone:______________________________ Cell:____________________________________
Email:______________________________________________________
Children: _________________________________ ________________________________
_________________________________ ________________________________
_________________________________ ________________________________
Annual Dues – Payable on the 4th Week of October of each Calendar Year
Single Membership - $15.00
Couple/ Family Membership - $20.00
Junior Membership - $5.00
(Junior members less than 16 years of age must be supervised by an adult relative or designated Club Member)
Club Magnetic Name Tags – May be ordered for a fee of $7.50 each
Pleas print clearly on the lines below the names required on each tag.
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_______________________________ 4. __________________________________
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_______________________________ 5.__________________________________
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_______________________________ 6.__________________________________
________________________________________________ ________________________
Signature Date
Make Payment to: Beehive Rock and Gem Club
Send to: Beehive Rock and Gem Club
P.O. Box 1011
Ogden, UT 84402
