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THE LAPIDARY &

MINERAL SOCIETY

OF CENTRAL CONNECTICUT

MEMBERSHIP APPLICATION

For a 1-year membership, please clearly and accurately fill out the form below

and mail the appropriate dues to:

Eva Kupisz, Treasurer LMSCC, 109 Indian Hill Road, Newington, CT 06111

or pay in person at a regular club meeting.

Dues are $15 family/household, $12 individual. 

Checks must be made payable to LMSCC.

For family memberships, please list all names of family members who will participate in club field trips. 

The club needs this information to make sure everyone is covered by our liability insurance.  

Membership cards can be obtained from the Treasurer at the regular monthly meetings,

or they will be mailed to you if requested.

Name(s)

Address

Phone

Email

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