New Member Application – Santa Lucia Rockhounds

Primary Member First Name

Primary Member Last Name *

Primary Email Address *

Phone

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal code *

Is this a family/group membership?YesNo

Additional Members

Name

Age (if minor)

Phone (if different from above)

Email Address (if different from above)

I learned about the club from...

Interests

I would like help getting started with:

I have some knowledge, training, or skill in the following area(s) that I want to further develop:

We encourage new members to get involved by participating in club activities. Please indicate your interest in helping with organizing or coordinating the following activities (please check all that apply):

Is there anything more you would like to tell us about you and your family?

All club member names, phone numbers, email addresses, and the city/town you live in are published in a roster which is available to the club membership. Information for minors is limited to name and email contact. By checking OPT IN on this application along with payment, you are agreeing to the release of this information to the club's membership on behalf of you and your group members. To be excluded from any rosters made available to the club membership, check OPT OUT.Opt InOpt OUT