POTOMAC SPELEOLOGICAL CLUB, INC.

MEMBERSHIP APPLICATION

To apply for membership in the Potomac Speleological Club (PSC), print out and complete this application, and submit with annual dues to:

PSC Membership
Bob Robins
13114 Serpentine Way,
Silver Spring, Maryland 20904

Make checks payable to: Potomac Speleological Club

By submitting this form and paying dues, you become an Applicant Member and are added to the mailing list for our newsletter, The Potomac Caver.

Name:                                                                                                                                    

Address:                                                                                                                                

City:                                                                State:              Zip:                                                     

Telephone Numbers (will be published in the annual PSC Membership List):

Home:                                                          Work:                                                       

email address:                                                                                                                       

Do you want to be added to the PSC Listserv?:                 

I, the undersinged, being over 18 years of age, in applying for membership in the Potomac Speleological Club, will abide by the Club’s Consititution and Bylaws and established policies toward conduct, safety, and conservation.

Signature:                                                                     Date:                                                


For Membership Committee Use Only:

Date joined:                                                      Amount paid: $                        

Date Completed regular membership requirements:                                                        

PSC Number:                         (Assigned when membership requirements have been completed)

Remarks:

___________________________________________ __________________________                       Membership Chair                                                               Date