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Nampa, ID Chapter of the Gold Prospectors Association of America
Membership / Renewal Form
PLEASE PRINT
Last Name :
________________________ Phone : ______________________ For Official Use Only
First Name(s): _________________________________ dob :
_________________________________
_____________
_____________
Date Paid : ______________
Intl: ___________________
___ Check
____ Cash
Amount: ________________
_________________________________
_____________ ____ New
____ Visitor
_________________________________
_____________ ____ Renewal
_________________________________
_____________
_________________________________
_____________ ____ Info Change Only
Address: _____________________________________________________________
City: ______________________________________ State: ______ Zip: ______
E-Mail Address: ______________________________________________________
Secondary E-Mail: ____________________________________________________
(Nampa Chapter newsletters and announcements will be emailed to you from the club secretary. If you do not have an email account,
you will be snail-mailed a hard copy of the newsletter and occassionally contacted by telephone with other pertinent club information.)
Emergency Contact Name: ___________________________ Phone: __________
Relationship: _______________________________________
Attention: Emergency name and phone number should be different than spouse. Thank you.
Current GPAA Membership #: __________________________
‫ ‫‬Not a member
Current LDMA Membership #: _________________________
‫ ‫‬Not a member
___ Yes ___ No – I am enclosing $12.00 to cover costs of communications, newsletter, postage & ID badge
___ Yes ___ No – I am enclosing $30.00 to cover costs of a mining guide
___ Yes ___ No – I am also enclosing an additional $________________ as a donation to help the club
___ Yes ___ No – Do you have a mining claim that you would be willing to open to club members for a club outing? (If yes, please
tell us where and when you would like to have the club there. Be sure you speak with the club president regarding club availability.)
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www.idahogpaa.com
Nampa GPAA Membership/Renewal
Interests:
1. I am interested in one or more of the following aspects of prospecting for gold (Please check all that
apply):
___ Mining Laws
___ Panning
___ High Banking
___ Metal Detecting
___ Mining Legislation
___ Sluicing
___ Rocker Boxes
___ Weekend Outings
___ Camel Wheels
_____________________
___ Rules of Nampa GPAA ___ Dredging
2. I have the following experience (check all that apply) :
___ None
___ Very Little
___ One or more years
___ I have so much experience the GPAA should have me as a guest speaker.
3. I would like to be contacted between Nampa GPAA Club meetings: ___ Yes
Best time to be reached : _________________________
___ No
@ Ph#: ____________________________
Volunteer Information:
__ Operate Equipment
___ Scouting Expeditions
___ Cook
___ Clean Up Committees
__ Haul Equipment
___ Telephone
___ Computer
___ Litter Control
__ Transport Supplies
___ Entertain Children
___ Musician
___ Wash Dishes
__ Pick-up Supplies
___ Outings Sponsor
___ ________________________________________
__ Newsletter
___ __________________ ___ ________________________________________
Comments and Suggestions:
How did you hear about Nampa GPAA? ___ Friend
___ Flyer
___ Newspaper ___ Other ____________________________
This form may be given to a Nampa GPAA Club Official or mailed to:
Nampa GPAA, PO Box 682, Nampa, ID 83653-682
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Nampa GPAA Membership/Renewal
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