NORTH COAST FOSSIL CLUB

Membership Application

Note: Those wishing to participate in meetings and fields trips of North Coast Fossil Club must apply for membership and sign the bottom of the form indicating that they agree to abide by the club constitution and policies. Members receive the quarterly newsletter free with their membership. Subscribers do not have membership privileges, but will receive a quarterly club newsletter.

Please makes checks payable to "North Coast Fossil Club" and mail to:

NCFC Treasurer

3595 Call Road

Perry, OH 44081

Annual dues ___ Individual $12.00 __ New __ Renewal

Category: ___ Family $17.00

___ Newsletter Only $10.00

Name ___________________________________ __Mr. __Mrs. __Ms. __ Dr.

Address ________________________________________________________________

City _____________________________ State _______ Zip ___________

Home Phone _____________________

Work phone _____________________ Fax _________________________

Email ___________________________________

Web site ______________________________________________________

Family memberships must include the following information on participating

family members:

Spouse ________________________________ Birth dates:

Children ________________________________ ____________

________________________________ ____________

By making this application I agree to abide by the Constitution and By

laws of North Coast Fossil Club, to conduct myself safely, courteously, and

ethically during all club fields trips and meetings, and to hold the club and

its officers blameless in the event of any injury or mishap to myself, family

members, or guests during club field trips, meetings, and other functions.

Signed: ___________________________________ Date ____/____/____

Total Amount Enclosed $ ___________ Paid by: __ Cash Check # __________

The following information is optional ...

How did you hear about our club? ____________________________________________

Reason(s) for joining ________________________________________________________

Your occupation ______________________________________________________________

Skills you could offer the group _____________________________________________

Special interests ____________________________________________________________

Would you consider serving on a committee or the board? _Yes _No _Maybe later

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Please makes checks payable to "North Coast Fossil Club" and mail to:

NCFC Treasurer

3595 Call Road

Perry, OH 44081