Mingus Gem & Mineral Club - Member information change

Please print your name and any changes you would like made

Name ______________________________________

Address ____________________________________

City_________________State ______ Zip _______

Phone _______________________ List: yes no

Email ________________________ List: yes no

Old Email _______________________________

Please submit at meeting or mail to:

Mingus Gem & Mineral Club,PO Box 1284 , Cottonwood, AZ 86326