BEDROCK PROSPECTORS CLUB INC.
P.O. Box 425 Puyallup WA. 98371

MEMBERSHIP APPLICATION FORM

Please type information on form and print from your Web Browser.

        Today's Date:    (mm/dd/yyyy)
        Name:   Spouses Name:  
        Address: 
        City:  State:   Zip Code:  
        E-mail address: 
        Home Phone: 
        Please Select Membership Type: New Membership     or      Renewal

JOIN for $30.00 Single or Family

Annual Dues thereafter $30.00

MEMBERSHIP AGREEMENT

As a member of the Bedrock Prospectors Club Inc, (I/We) hereby agree to abide by the rules and bylaws of the Bedrock Prospectors Club.
(I/We) acknowledge that small scale prospecting may involve inherent dangers and (I/We) hereby release the Bedrock Prospectors Club, its Officers, and claim holders from any and all actions, causes of actions, claims, damages, or Injuries that may occur on any and all claims controlled by the Bedrock Prospectors Club.
(I/We) further agree to hold the Bedrock Prospectors Club, its Officers, Members and Claim Holders harmless:
from the results of any accidents or incidences that may occur while ( I ) or ( We are ) on said lands
controlled by Bedrock Prospectors Club Inc., or at Bedrock Prospectors Club Sponsored Outings.

Signature________________________________ Date ____________________

Signature________________________________ Date ____________________

( MUST be signed by Spouse for Family Membership )

Make checks or money orders payable to: Bedrock Prospectors Club Inc.
Mail to: Bedrock Prospectors Club, P.O. Box 425 Puyallup WA. 98371
If you any questions please contact Richard Holcomb, or phone:  (253)359-5890