FMS  Application  Form

To join the Fluorescent Mineral Society, Incorporated  -   please print out this page, fill in the details, and mail it with the appropriate payment to:

Please PRINT or TYPE the following:

Name:  ____________________________________________________________

Address:  __________________________________________________________

City:  ___________________________   State: _______   Zip: ___________

Country:  _____________________

Work Telephone:  (____) _____________________

Home Telephone:  (____) _____________________

Electronic-mail address (if any):  ________________________________

FMS Member Profile

While it is not required, please take a minute to fill out the questionnaire. Your answers will be shared only with other FMS members, and it will help us respond to your interests. Suggestions for improving the FMS are always welcome. Please feel free to include a note with any additional comments. 

1.   Name:		____________________________
     Occupation:	____________________________
     Member of what clubs or professional societies:
		____________________________
     		____________________________
     		____________________________

2.   What is it about fluorescent minerals that interests you most?
	Please rank these according to your degree of interest:
               (1=greatest interest)
	___ Collecting Franklin (NJ) fluorescent minerals
	___ Collecting shortwave UV fluorescent minerals
	___ Collecting longwave UV fluorescent minerals
	___ Displaying fluorescent minerals
	___ Fluorescent mineral field trips
	___ Luminescence-related science
	___ Other - please specify: ________________________________________

3.  Are you active in any of the following related hobby interests?
	Please rank these according to your degree of interest:
               (1=greatest interest)
	___ Fluorescent Minerals      ___ Jewelry & Metalcraft
	___ Nonfluorescent Minerals   ___ Fossils
	___ Thumbnail Minerals        ___ Artifacts
	___ Micromounts               ___ Sand
	___ Lapidary                  ___ Books about Minerals
	___ Faceting                  ___ Mining Memorabilia
	___ Other - please specify: ________________________________________

4.   How long have you been actively interested in fluorescence? ___________

5.   What kind of ultraviolet light(s) do you have?
	Manufacturer: _________________  Model: _____________ Battery  AC
	Manufacturer: _________________  Model: _____________ Battery  AC
	Manufacturer: _________________  Model: _____________ Battery  AC
	How long have you owned it (them)? _________________________________

6.   Have you displayed your fluorescent minerals at a club or show? Yes  No
	Local show   Regional show   Other: ________________________________
	When or how often? _________________________________________________

7.   Have you ever given a talk on fluorescent minerals?   Yes  No
	Where? _____________________________________________________________

8.   What magazines do you read?  (1-regularly, 2-occasionally, 3-never)
	___ Mineralogical Record    ___ Rocks & Minerals    ___ Mineral News
	___ Lapidary Journal        ___ Rock & Gem          ___ Lapis
	___ Other - please specify: ________________________________________

9.   What is your age range:
      Under 20    20-30    30-40    40-50    50-60     60-70    over 70

10.  What books/booklets do you have or have you read?
	"Fluorescent Mineral Collecting..." - Bostwick
	"Where to Collect Fluorescent Minerals" - Blazek
	"The Story of Fluorescence" - Raytech
	"Ultraviolet Guide to Minerals" - Gleason
	"Guide to Mineral Collecting at Franklin..." - Kuschner
	"Nature's Hidden Rainbows" - Jones
	"The Henkel Glossary of Fluorescent Minerals" - Henkel
	"The Collector's Book of Fluorescent Minerals" - Robbins
	"Fluorescence: Gems & Minerals Under Ultraviolet Light" - Robbins
	"Ultraviolet Light and Fluorescent Minerals" - Warren, et al.
	"Franklin and Sterling Hill, New Jersey: the world's most magnificent
            mineral deposits" - a monograph by Dr. Pete J. Dunn, 
                                in 5 volumes and 2 supplements
	Others - please specify: ___________________________________________

11.  Are you interested in trading fluorescent minerals with other members?
       ____  Yes, please send me a trading application form.

12.  Please describe your fluorescent mineral collection in brief.

	Roughly what percentage of your fluorescent specimens are in each category?
	___ Minerals Fluorescent with Shortwave UV only
	___ Minerals Fluorescent with Longwave UV only
	___ Minerals Fluorescent with Both Shortwave and Longwave UV
	___ Franklin (NJ) minerals
	___ Minerals from one state or province (that state with the largest percentage)
	___ Minerals from one nation (that nation with the largest percentage)

	Number of fluorescent specimens:
	  Less than 20   20-50   50-100   100-500   More than 500

	Have you cataloged your minerals?    Most   Some   None

	How do you mostly obtain your fluorescent minerals?
	Please enter rough percentage estimates 
	  ___ Field trips   ___ Trade   ___ Buy

13.  How did you learn of the FMS? ___________________________________________

Member Release - required for field activities

I state that I wish to participate in activities offered by the Fluorescent Mineral Society, Inc. (hereinafter referred to as "FMS").   I RECOGNIZE THAT ANY FMS ACTIVITY MAY INVOLVE CERTAIN DANGERS.   I certify that I am aware of all of the inherent dangers of FMS activities, including but not limited to: damage to, or loss or destruction of equipment, accidents or illness in remote areas without medical facilities, the forces of nature, and actions of any other members, any participants, or any other persons all of which may result in personal injury, death, property damage or other losses.

In consideration for the right to participate in FMS activities, I HEREBY RELEASE FMS AND ITS DIRECTORS, OFFICERS, INSTRUCTORS AND MEMBERS FROM ANY AND ALL LIABILITY, CLAIMS AND CAUSES OF ACTION WHICH I MAY HAVE ARISING FROM MY PARTICIPATION IN FMS ACTIVITIES.   The terms of this agreement will serve as a release and indemnity agreement for my heirs, personal representative, and for all members of my family, including any minors.

I further state that I am eighteen (18) years of age or older and legally competent to sign this release, that I understand these terms are contractual and not a mere recital, and that I have signed this document as my own free act.   (Parents or legal guardian must sign for all persons under eighteen (18) years of age).

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS RELEASE AND INDEMNITY BY READING IT BEFORE I SIGNED IT.