Application To
Gold Searchers of Southern Nevada Inc.
P.O. Box 96732
 Las Vegas, Nevada 89193-6732
Phone 393-GOLD (4653)
 Please Print Clearly

Last Name ________________________ First  _____________ Spouse ________________________

Address __________________________City _______________State ________ Zip ______________

Phone ___________________________ E-Mai l__________________________________________

Prospecting Vehicle    Year________ Make _____________ Lic.# _______________ State __________

I understand that as a member of the Gold Searchers of Southern Nevada Inc., 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 claims, subject to the Club By-Laws. I can also use Club equipment by appointment and check books and videos out of our extensive library.

HOLD HARMLESS AGREEMENT

I / we, the undersigned, (hereafter referred to as participant) assume all risk and/or hazards associated with participant’s involvement in the Gold Searchers of Southern Nevada Inc., a prospecting Club. Participant agrees to indemnify and hold harmless all Club Officers, Sponsors and/or other third, fourth, etc. Parties involved in Club activities. Participant realizes that metal detecting, gold prospecting and associated activities can be dangerous. The terrain can be hazardous, and there may be wild and domestic animals and snakes present. Some locations may have open shafts, pits and tunnels. Participants assume all responsibility by signing below.

SIGNATURE             ______________________________________________

CLUBS ONLY FUNCTION IF MEMBERS VOLUNTEER
I/we will volunteer to assist in the areas checked. Please check at least one area.

COMMITTEES
Outings [ ] Food [ ] Claims [ ] Education/Training [ ] Newsletter [ ] Membership [ ] Website [ ] Ticket Sales [ ] Librarian [ ]

ELECTED OFFICES
President [ ] Vice-President [ ] Secretary [ ] Treasure [ ]

DUES ARE PAYABLE ON THE FIRST OF THE MONTH ON YOUR ANNIVERSARY DATE
New members $45.00 Renewals $30.00

Check #__________Cash________ By_________

Receipt # __________ From_____________ To______________

Card # ________ Card Sent ______________ Claims book sent ______________