Desert Gold Diggers - DGD Membership Application

Membership Application-Renewal-Release-Name Badge Order

Type and print from your Web Browser.Today's Date:

Change of Addess: Check here if following is for change of address also.
Name: Nick Name:
Address: Home Phone:
City: State: Zip Code:
E-mail address:
Name Of Spouse: Work Phone:
How did you hear about the Desert Gold Diggers?

*$10.00...... Members name as to appear on badge:
$ 9.00....... Spouse's name as to appear on badge:
$ 9.00....... Each Child when ordered w/parent: name on badge:
$ 4.00....... If you need the material mailed, add $4.00 to cover mailing costs.
$ AMOUNT RECEIVED Via check. DO NOT MAIL CASH!

Disclaimer/ Release:
BY AFFIXING MY SIGNATURE BELOW, I ACKNOWLEDGE THAT PROSPECTING AND PROSPECTING LOCATIONS CAN BE DANGEROUS WITH NUMEROUS NATURAL AND ARTIFICIAL HAZARDS. BY SIGNING UP, AS A MEMBER OF THE DESERT GOLD DIGGERS INC. , I / MY SPOUSE / MY FAMILY / AND/OR MY GUESTS AGREE TO RELEASE THE DESERT GOLD DIGGERS INC. , THEIR OFFICERS OR ASSIGNEES AND / OR PRIVATE PROPERTY OWNER(S) FROM ANY LIABILITY INCURRED DURING PROSPECTING OPERATIONS / OUTINGS. I FURTHER AGREE TO HAVE ANY GUESTS ACCOMPANYING ME TO ONE OF THE " CLUBS " CLAIMS , ON A PRIVATE OUTING, TO SIGN A " CLUB " WAIVER PRIOR TO THE OUTING.

Signature:____________________________________________ Date:___________________

Spouse:______________________________________________ Date:___________________

Desert Gold Diggers Dues * Check the appropriate box(es) *
	Dues amount for 12 months of NEW RENEWED membership.
$	DGD Gazette monthly newsletter via e-mail $ 30.00 (Provide email address above.)
	DGD Gazette monthly newsletter via USPS Mail $ 35.00