Alabama Mineral & Lapidary Society
Membership RENEWAL
>>>>> Please complete this form and hit the "Submit" button at the bottom of the page. <<<<<

Name

Type of
Membership

Single - $20
Family - $25
Junior/Student - $15
Address
City/State/Zip

Primary Contact
Telephone #  		Home
Work
Cell
 Secondary Contact
Telephone # 		Home
Work
Cell
Member's E-mail 
>>>>> Stop here unless you are renewing a Family membership! <<<<<
Spouse or Other
Family Member's Name 
Spouse or Other
Family Member's E-mail 

Children's Name(s)
and Age(es)
We're not being nosy. We need your children's names and ages for insurance. If you do not provide the information, your children will not be able to go on club field trips.
Spouse or Other
Family Member's
Primary Contact
Telephone # 		Home
Work
Cell
 Spouse or Other Family Member's
Secondary Contact
Telephone #  		Home
Work
Cell