Friends of the CSM Geology Museum Application

Friends of the CSM Geology Museum Application Form Name: ________________________ Street Address: ________________________ City, State/Province, Zip/Postal code:________________________ Country:________________________ Home Phone:________________________ Cell Phone:________________________ E-mail address:________________________ Membership dues: _____ Student - $10 _____ Individual - $30 _____ Family - $50 _____ Patron - $100 _____ Prospector - $500 _____ Miner - $1,000 _____ Mogul - $5,000 _____ Magnate/Corporation - $10,000 This membership is: _____ New _____ Renewal _____ Gift from (name): ________________________ Street Address: ________________________ City, State/Province, Zip/Postal code:_________________________ Country:_________________________ Areas of interest (circle all that apply): artistry/illustration/graphics, behind-the scenes tours, book signings, Colorado geology, community outreach, computing/info services, exhibit previews, fundraising, gemstones/jewelry, geologic “art,� lectures, leading/organizing field trips, legal issues, library research, mailings/distributions/public relations, meteorites, minerals, mining artifacts, mining history, newsletter, organizing parties/functions, paleontology, photography, planning and budgeting, railroads, special programming, website design, workshops, OTHER _____________________ Some Friends events that I would like to participate in would be: _____ I would be interested in serving as a Friends board member Please make your check payable to: CSM Geology Museum And mail it to: CSM Geology Museum 1310 Maple Street Golden, CO 80401