MEMBERSHIP APPLICATIONS
Complete following application and send $20 Dues in check or money order (Please no Cash) to :
Membership Chairman
Eileen Mizerk Phone Number (630) 289-7736
2094 Windward Lane E-mail emizerk@comcast.net
Hanover Park, Illinois 60133
ESCONI FAMILY MEMBERSHIP APPLICATION FORM
Ms. Mrs. Mr. _____________________________Spouse’s Name ________________________________
Address(Street): __________________________________________
City State Zip: ___________________________________
Telephone No.: Home ______________________________ Work _________________________
E-Mail.: _____________________________
Children: (First Name) ____________________________________ Age _______________
____________________________________ _______________
____________________________________ _______________
Occupation: ______________________________________________________________________
How did you learn about ESCONI?______________________________________________________
____________________________________________________________________________________
What are your family interests?
| ˙ ARCHAEOLOGY (Early History) |
| ˙ LAPIDARY (Rock Polishing, Gems, Etc.) |
| ˙ MICROMOUNTS (Closeup Study of Minerals) |
| ˙ MINERALOGY (Minerals and Crystals) |
| ˙ PALEONTOLOGY (Fossils) |
| ˙ FIELD TRIPS (Rock Hunting, Museums, etc.) |
| ˙ JUNIOR GROUP |
| ˙ OTHER (Describe) _____________________ |
Do any family members have special skills or collections in the earth sciences to share
With the Club? ____________________________________________________________________
Last Updated 9/18/2007
Number Of Visitors Since 2/3/2005