New Member: ______ Change Information:_______Renew Membership:_____ 

NAME: ____________________________________________________________________

ADDRESS:__________________________________________________________________

CITY:______________________________________STATE:____________ZIP:__________

 SPOUSE NAME:_____________________________________________________________

BIRTHDAY:     Yours:_____________________________Spouse:________________________

WEDDING ANNIVERSARY:_____________________________________________________

CHILDREN in HOUSEHOLD:

NAME:________________________________________BIRTHDAY:___________________

NAME:________________________________________BIRTHDAY:___________________

Please list your interests_______________________________________________________

ANNUAL MEMBERSHIP DUES

$20.00 per family household

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If dues are paid after July 1st

July 1 - December 31 = $10.00

Mail your check and application to:

Carroll County Gem & Mineral Society

Post Office Box 2604

Carrollton, GA  30112

ANNUAL MEMBERSHIP DRIVE

January 1 - March 1

Contact us

We have Junior Members, too!