Superstition Mountain Treasure HuntersMembership Application

******************************940 W. Apache Trail

P. O. Box 1200 Apache Junction, AZ 85219Tele. 480-983-3484 Fax. 480-983-3279

e-mail: smth03@hotmail.comWebsite: smtreasurehunters.com

Application for membership must be accompanied by cash, check or money order for $75.00 payable to SMTH. Annual dues are for member and spouse/significant other and minor children. Badges will only be issued to the member and the member’s spouse/significant other. Member’s minor children do not require a badge.

Please complete information below.

Member Name:__________________________________________________________________

Spouse/S.O._____________________________________________________________________

Local Address___________________________________________________________________

__________________________________________City__________________State___________

Telephone Number ( )_____-__________ Cell Ph.__________________________________

Children under 18 years old yes [ ] no [ ] How many?______

Name(s)________________________________________________________________________

Note: If you are not here all year long, please complete the information below so you won’t miss any newsletters.

Please notify us when to change your mailing address.

Alternate mailing address_________________________________________________

__________________________________State___________

In Arizona From _______________________To _______________________________

I HAVE READ AND ACCEPT THE SMTH CLUB RULES & REGULATIONS:

Signature _______________________________________________________ Date _________________

Revised 11/03/2005