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___________________________ ___________________________ ______________________

(Last Name) (First Name) (Spouse)




City __________________________________ State ___________ Zip __________- ___________


Day Phone _____________________ Evening Phone _____________________________________


Mailing Address [ same ( ) ] __________________________________________________________


City ___________________________________State _______ Zip ________- ________

Yearly membership dues are $30.00 (Family members included). Yearly dues are due in December. Initiation Fee (new members) is $60.00


Type Prospecting Vehicle Make (YR) _______________________ Color _______ Lic. # (ST)__________

Additional Vehicle Make (YR) _______________________ Color _______ Lic. # (ST)__________


Metal Detector: None ( ) Make _______________________________Model_____________________

Other Equipment ( Example: Gold King drywash ) _____________________________________________




Member of GPAA Yes [ ] No [ ]

Member of any other Prospecting Clubs: Name ________________________________________________


I understand as a member of the Havasu Gold Seekers I can run for office and participate in the voting on all major policies and officer elections. I will also be able to attend all meetings and use the Club Gold claims subject to the Club by-laws.


Signature ______________________________________________Date__________________

Bring this application to the next Club meeting or mail this application and you check to :


Havasu Gold Seekers, Inc. P.O. Box 3281 Lake Havasu City , Az. 86405 3281


PS: The dues are used to send out a monthly newsletter, pay misc. expenses, and pay the fees on all of the Club Gold Claims



Club Bookkeeper Only


Date received __________ Initial ____ Amount Received $________ Check # _______ Cash________


Havasu Gold Seekers App. 9-16-1999 dm