MEMBERSHIP APPLICATION

(805) 529-2524

Conejo Gem and Mineral Club

Additional Information

CONEJO GEM & MINERAL CLUB

MEMBERSHIP APPLICATION

I hereby apply for membership in the Conejo Gem & Mineral Club, Inc.

I agree to abide by the Constitution and the Bylaws and all Rules and

Regulations of the Club. I further agree to abide by the code of Ethics

of the American Federation of the Mineralogical Societies.

Date:______________Phone:___________________Signature:______________________________

Name(s)_____________________________________________________________________________

Address:____________________________________________________________________________

E-mail address:__________________________________________________

Name:_____________________________ Birthday (Month ___________

Interests: Field trips__, Minerals__, Fossils__, Lapidary-Jewelry arts__, Carving-Sculpture__, Education__, Faceting__, Fluorescent minerals__, Meteorites__, Mining history__, Micro mounts__, Photography__, Silversmithing____, other____________________________________________________________

How long have you been interested in earth science, rock hounding?________________

Dues and Fees:

Single-1 adult: $28.00 per year in advance (includes new member badge)

Family

2 adults, family members: $45.00 per year in advance (includes new member badges)

Renewals: Family $30 a year Single $20 a year

Please bring to a meeting or mail this completed and signed application with the appropriate fees to the Membership Chairman. The check is to be made out to CGAMC.

AFMS CODE OF ETHICS FOR ROCKHOUNDS

I will respect both private and public property and will do no collecting on privately owned land without the owner’s permission.

I will keep informed on all laws, regulations or rules governing collecting on public lands and will observe them.

I will, to the best of my ability, ascertain the boundary lines of property on which I plan to collect.

I will use no firearms or blasting material in collecting areas.

I will cause no willful damage to property of any kind--fences, signs, buildings, etc...

I will leave all gates as found.

I will build fires in designated or safe places only and will be certain they are completely extinguished before leaving the area.

I will discard no burning material--matches, cigarettes, etc...

I will fill all excavation holes, which may be dangerous to livestock.

I will not contaminate wells, creeks, or other water supply.

I will cause no willful damage to collecting material and will take home only what I can reasonably use.

I will support the round project H.E.L.P (Help Eliminate Litter Please) and leave all collecting areas devoid of litter, regardless of how found.

I will cooperate with field trip leaders and those in designated authority in all collecting areas.

AGREEMENT OF WAIVER OF RESPONSIBILITY

In consideration of the privilege and opportunity given to me to attend the Field Trips, use of the Lapidary shop, and other activities of the Conejo Gem and Mineral Club. I hereby agree that I will henceforth make no claim against the Conejo Gem and Mineral Club or any of it’s members for injuries of myself, members of my family, my agents, or third persons, arising out of my attendance of Field Trips or other activities of the club. I further agree to indemnify and hold harmless the Conejo Gem and Mineral Club and or it’s members, against the claim of the claim arising out of their attendance at any club activity, including use of the Lapidary shop.

Signed:______________________________________________

Date:_______________

All Junior and Pebble Pups MUST sign and state their ages. Parents or Guardians of Junior members and Pebble Pups must countersign this waiver

Signed:______________________________Age/Birthdate:_________________

Please turn in this completed and signed waiver to:

Phyllis White

VP Membership

rich_phil1025@att.net

CONEJO GEM & MINERAL CLUB

MEMBERSHIP APPLICATION

I hereby apply for membership in the Conejo Gem