Send Application To

SEND APPLICATION TO

WEGM MEMBERSHIP DIRECTOR P.O. BOX 910 DAHLONEGA, GEORGIA 30533

PLEASE PRINT LEGIBLY ATTACH COPY OF DRIVER'S LICENSE OR STATE ISSUED PHOTO ID

ADDRESS:

CITY: STATE: ZIP CODE:

PHONE: [ ] EMAIL:

SPOUSE: CHILDREN UNDER 21:

HAVE YOU EVER BEEN A MEMBER OF WEGM? YES [ ] NO [ ] IF YES, SEE BELOW : WEGM BY-LAWS require you to request a hearing from the Board of Directors to be re-instated as a member. This request must be in writing or email within five (5) days of next regularly scheduled monthly meeting.

RELEASE OF LIABILITY I, recognize that mining and prospecting are inherently dangerous, and that the club's lease's 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 Prospecting Club Inc. or the land owners and covenant not to sue for any damages, injury or death caused to me, or for the loss of equipment or personal items while on the lease's. 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 or my actions while on the lease's.

FINANCIAL WAIVER I, being accepted as a member of the WEEKEND GOLD MINERS PROSPECTING CLUB INC. do here-by agree to abide by the by-laws and rules and regulations of WEGM. I understand that this is a contract for a $2000 membership, plus a $50.00 yearly maintenance fee. I understand that if I do not pay my dues and maintenance fee, my membership will be terminated and I will be responsible for the remaining balance, unless approved by the Board of Directors. I must petition the Board of Directors to terminate my membership by sending a written request to: WEGM Board of Directors, P.O. Box 910, Dahlonega, Ga. 30533. Upon approval of termination from the Board of Directors I must return my membership card and property gate key, if these items are not returned they can be repossessed by WEGM by whatever legal means necessary and that I may be held responsible for any cost of such legal action. I further understand that the total cost of membership is $2000.00* payable in monthly install- ments of $35.00* with a yearly maintenance fee of $50.00* or $1750.00* if paid in full on date joined with a yearly maintenance fee of 50.00 * Subject to change. I have read and understand this application in it's entirety,

SIGNATURE:______DATE: ______

WEGM USE ONLY BELOW THIS LINE ______

Amount Received: $ How paid: Cash [__] Check [__] Check Number [ ]

Money order [__] M.O. Number [ ]

The above individual was accepted as a member on date application signed.

Individual has been assigned membership number [______] on this date [______]

Membership Director Signature: