ANTELOPE VALLEY TREASURE HUNTER'S SOCIETY

CLUB MEMBERSHIP APPLICATION - Mail to: AVTHS, P.O. Box 4718, Lancaster, CA. 93539

LAST NAME__________________________FIRST____________________________________

SPOUSE______________________________# OF CHILDREN UNDER 18________________

ADDRESS______________________________________________________APT#___________

CITY_________________________________STATE____________________ZIP____________

PHONE #_____________________________E-MAIL___________________________________

NAMES OF OTHER CLUBS YOU BELONG_________________________________________

PRINT WAY YOU WANT NAME(S) ON BADGES(S)__________________________________

OPTIONAL INFORMATION

OCCUPATION___________________________________________________________________

TREASURE HUNTING/PROSPECTING EXPERIENCE________________________________

FAMILY BIRTHDAYS (Month & Day)_______________________________________________

MEMBERSHIP FEES

Initiation Fee $25.00...............................................Annual Dues $35.00

( ) Cash..........( ) Check........... Total Enclosed $___________Date________________

IMPORTANT NOTICE: Memberships are annual from January 1st through December 31st. Initiation fee and dues are payable when you join. The initiation fee, plus dues, will be charged to those who have let their annual membership lapse more then one year. Annual dues must be paid no later than March 1st. If joining after January, dues are to be paid at the rate of $3.00 per month for the remaining of the year.

CLUB USE:

( ) Membership......( ) Treasurer......( ) Editor......( ) Secretary......( ) Badges......( ) Membership Kit