Granite State Treasure Hunters Club for Historic Preservation

Membership Application

Circle One:   NEW  or  RENEWAL

________   $20.00 First family member.
________   $10.00 Each additional family member: (under 16 yrs. free)
________   $15.00 Associate Membership: (under 16 yrs. no other family member in club)
________   $5.00 First time initiation fee. (Prior members inactive for 3 years need to pay initiation fee).
________   TOTAL

Name: _____________________________________________ Date of birth: _________________

Street: ______________________________________________ Todays date: ___________________

City: ____________________________________________ State _________ Zip: _____________

Telephone: (_____) _____________        Email address : __________________________

Additional Members of same family joining from same address:

Name: ___________________________________________ Date of birth: ____________________

Name: ___________________________________________ Date of birth: ____________________

Name: ___________________________________________ Date of birth: ____________________

     Do you wish others to have your telephone number?      YES ____    NO ____
     Do you wish to be on the club alert plan?                       YES ____    NO ____
     Do you want your birth month published?                      YES ____    NO ____

Please make all checks payable to: Granite State Treasure Hunters Club and mail to:

Mr. Frank Minakin
Treasurer, GSTHC
184 Depot Rd
Auburn, NH 03032-3221
If you have any questions call Frank evenings at
(603) 483-8040 or e-mail him at gravelbank@comcast.net

Please use this form when paying your annual club membership dues and for information updates.
(Please make copies of this form for others wishing to join.)