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Week End Gold Miners
Membership Application

Thanks for making the decision to join our prospecting club. You are joining a friendly group of fellow prospectors that will welcome you and your family. Please print out this application form, fill it out and send it to the following address:

Weekend Goldminers
Benny Chester (Membership Director)
678-776-1807
benny_chester@yahoo.com

<TBODY>NAME :
PHONE NUMBER : (_______)
ADDRESS :
CITY:	STATE:	ZIP:
SPOUSE'S NAME:
Children Under 21 : </TBODY>

Release of Liability

I recognize that mining and prospecting are inherently dangerous, and that the club's properties have unmarked and unidentified hazards, to include abandoned mine shafts, caves, sink holes, steep slopes and other people, both invitees, licensees and trespassers and that any one or combination of the above can cause injury or death. I waive any claim against the Week End Gold Miners, Inc. or the land owners and covenent not to sue for any damage, injury or death caused to me, or for the loss of equipment or personal items while on the properties. I further recognize that there are special dangers to minors and I shall assume all responsibility for each minor accompanying me. I further agree to carry such insurance as I feel necessary to protect my interest and to indemnify and hold harmless owners from any liability arising out of my actions while on the properties.

<TBODY>I Want To Be A Member:
______________________

Please send more info :
______________________</TBODY>

Guest of Member Name? _________________

Member No ___________ </TBODY>

<TBODY>Signature :

Application Date: </TBODY>

Please allow 2-3 weeks for your information or
Membership Package to arrive.

<TBODY>$90 Initial Fee

$20 Monthly Dues

$1500 Total Lifetime Membership</TBODY>

$25 Yearly Maintenance Fee

<TBODY>WEGM Club Use Only In This Area
Amount Received : $	How Paid : Check ___ or Money Order ___
	Check or Money Order # :
The above named individual is ACCEPTED for membership and has been assigned the membership number ____________.
Application Accepted Date : __________________________		Membership Director Signature: ______________________________