LIMAGS Membership Application

Name ______________________________          Date________________________

Address_____________________________          Zip Code____________________

Town______________________________           Phone #_____________________

Occupation_________________________            Email_______________________

Check One Membership:     _____Individual @ $15.00       _____Family  @ $25.00

For Family Membership Only - Please list below all household family members:

_____________________    ____________________     ______________________

Please Note: That each family member must be in good standing for each to receive LIMAGS benefits.

                                                   Check Your Interests:

               _____Fossil Collecting                 _____Mineral Collecting

               _____Lapidary Work                   _____Jewelry/Beading

               _____Mineral/Gem Shows         _____Gemstones

               _____Field Trips                          _____General Geology & Earth Science

               _____Other(s) (Please list) _________________________________


Note: You may bring this completed application and fee to a monthly club meeting held the second Monday evening each month at the George Young Community Center at 446 South Jamesport Road in Jamesport, LI, New York.



Send completed form and membership fee to:

   Long Island Mineral & Geology Society

                        P.O. Box 320

            Mattituck, New York 11952