Society Annual Renewal Form

1Basic Details

2Primary Officers

3Officers & Chairs

4Dues Renewal

5Comment / Message

2021 Basic Details

Society Name *

Society Acronym

Society Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Is your meeting address different from the above Society Mailing Address?

Society Meeting Address

Address Line 1

Address Line 2

City

State

Zip Code

Only fill this in if your society meeting address is different from your society mailing address.

Society Phone

Society Email

Society Website

Social Media URL

For example, your society's Facebook page's URL.

When are Elections Held?

When are Officers Installed?

Does your Society hold a show, auction or symposium?

What is the date of your event?

Use this space for additional information about your event(s):

What is the name of your Society's newsletter?

How often is your newsletter published?

Is your newsletter published to your website?

Is your newsletter emailed or snail mailed to subscribers?

Emailed
Snail mailed
Both

Is your newsletter available to members only?

Members Only
Publically Available

Please list any additional information that you would like shown in your Directory listing

2021 Primary Officers

EFMLS Liaison Full Name

EFMLS Liaison Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

EFMLS Liaison Phone

EFMLS Liaison Phone 2

EFMLS Liaison Email

President Full Name *

President Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

President Phone *

President Phone 2

President Email

Vice President Full Name

Vice President Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Vice President Phone

Vice President Phone 2

Vice President Email

Treasurer Full Name

Treasurer Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Treasurer Phone

Treasurer Phone 2

Treasurer Email

Secretary Full Name

Secretary Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Secretary Phone

Secretary Phone 2

Secretary Email

Newsletter Editor Full Name

Newsletter Editor Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Newsletter Editor Phone

Newsletter Editor Phone 2

Newsletter Editor Email

Do you have any additional officers?

List them in the box above.

Who is filling out this form?

Your full name *

Your position/title *

Your email *

Your phone number *

Alternate phone number

Your mailing address *

Address Line 1

Address Line 2

City

State

Zip Code

Additional Officers & Chairs

Show Coordinator Full Name

Show Coordinator Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Show Coordinator Phone

Show Coordinator Phone 2

Show Coordinator Email

Field Trip Coordinator Full Name

Field Trip Coordinator Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Field Trip Coordinator Phone

Field Trip Coordinator Phone 2

Field Trip Coordinator Email

Membership Coordinator Full Name

Membership Coordinator Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Membership Coordinator Phone

Membership Coordinator Phone 2

Membership Coordinator Email

Outreach / Education / Youth Program(s) Coordinator Name

Outreach / Education / Youth Program(s) Coordinator Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Outreach / Education / Youth Program(s) Coordinator Phone

Outreach / Education / Youth Program(s) Coordinator Phone 2

Outreach / Education / Youth Program(s) Coordinator Email

Additional Officers or Chairpersons:

2021 Dues Renewal:

Society Name *

Society Acronym

Does your society participate in EFMLS insurance coverage? *

Number of members to be covered by liability insurance

Liability is $3.50 per individual.

Number of members to be covered by accident insurance

Accident and Health is $2.40 per individual.

Number of paying society members

$1.75 per individual (waived for 2021. See note at bottom of page)

Number of youth members (17 & under)

Total Check Amount

Check Number

Check Dated

Send Check to: EFMLS Treasurer
PO Box 8103, Hampton VA 23666-8103.
Make sure to clearly state your society name so we can properly credit your payment.

Do you wish to order member cards? *

How many cards do you wish to order? *

IMPORTANT NOTICE! 2021 Annual Membership Dues Waived.

The 2021 Annual Dues of $1.75 per individual Society member has been waived due to the COVID-19 Pandemic.
(Proposal was ratified on 8/17/20 by the EFMLS Board)

Comment / Message

Did you find this process easier and more efficient? *

The Eastern Federation of Mineralogical and Lapidary Societies, Inc

Society Annual Renewal Form

2021 Basic Details

2021 Primary Officers

Who is filling out this form?

Additional Officers & Chairs

2021 Dues Renewal:

Send Check to: EFMLS TreasurerPO Box 8103, Hampton VA 23666-8103. Make sure to clearly state your society name so we can properly credit your payment.

IMPORTANT NOTICE! 2021 Annual Membership Dues Waived.

Send Check to: EFMLS Treasurer
PO Box 8103, Hampton VA 23666-8103.
Make sure to clearly state your society name so we can properly credit your payment.