Membership Application

MONROVIA ROCKHOUNDS                 

Membership Application                                                  

Monrovia Rockhounds          

P.O. Box 553                                                            

 Monrovia, CA 91017      

Please print your information.

NAME_____________________________________________________________________

FULL ADDRESS_____________________________________________________________

(  ) I want my address on the roster     (  ) I do not want my address on the roster

HOME PHONE:  ______________________________

CELL PHONE:  _______________________________                 

(  ) I want my phones on the roster      (  ) I do not want my phones on the roster

BIRTHDAY:  (month/day only)  ________________

(  ) I want my birthday on the roster      (  ) I do not want my birthday on the roster

E-MAIL ___________________________________________

(  ) I want my email on the roster      (  ) I do not want my email on the roster

FIRST/LAST NAMES OF FAMILY MEMBERS:  _____________________________________

____________________________________________________________________________

Fees             Individual Membership  $20.00…………………………………………………..$_________ 

                     Each additional person in same household $10.00 each……………………..$_________

                     Initiation Fee & Name Badge $10.00 each  (Mandatory for membership)     .$_________                               

Names for Badges _______________________________     ________________________________

You must attend 2 MOROKS Meetings or club events to be eligible for membership:

Date ___________________________                Date ______________________________

Signature  ____________________________ Date of Application___________________

Sponsor (print)_____________________________________________________________

(If you do not have a sponsor one will be assigned.)

Membership Accepted  □       Membership Denied  □                      

Date of Board Decision _______________  MOROKS President ______________________      

Amount of dues received $________ Check #________ Cash $_________ Date recd.______