| Name:_____________________________________ |
Date: _____________________ |
| |
Last |
First |
M.I |
|
|
| Address: ________________________________________________________________________________ |
| |
Street |
Apt.# |
City |
State |
Zip |
| Telephone:
( ___ ) ____________________ |
|
|
| Employer: (or school
if you are a student)_____________________________________________________ |
| Business Address:
_______________________________________________________________________ |
| |
Street (or P. O.
Box #) |
City |
State |
Zip |
| Company Phone: (
___ ) _________Ext.# ____ |
Fax: ( ___
) _____________ Ext. #_____ |
| Job
Title ________________________ |
E-Mail
address:___________________ |
- I prefer to receive GSH mail
at my ______ Home Address ______ Business Address
- OPTIONAL: Spouse's Name ____________________
| Interested
in joining GSH Auxiliary? |
_______ |
Yes |
_______ |
No |
MEMBERSHIP QUALIFICATIONS
| 1. Are you currently a member of the Society
of Exploration Geophysicists? |
___ |
Yes |
___ |
No |
- Check membership classification
below and enclose copy of current SEG membership card
with this application.
|
___ |
Active |
___ |
Associate |
___ |
Student |
If requesting same classification
of GSH membership, skip Items 2 through 7 and complete Item 8.
2. If you are not an SEG member or are applying for
an upgraded GSH membership, are you now engaged in practicing
or teaching geophysics or related science?
| 2a.
How many years of practicing
or teaching? |
__________Years |
| 2b. If you hold a degree in geophysics
or related science indicate which: |
| |
Bachelor's
degree enter 4 on the following line |
|
| |
Master's
degree enter 5 on the following line |
|
| |
Doctorate
degree enter 7 on this line |
_____________ |
| |
|
|
|
|
| Add
lines 2a and 2b: Total years of experience |
___________ |
If your total years of
experience is 8 or greater, and you are applying for Active Membership,
skip Items 3 and 4 and complete Items 5, 6, 7, and 8.
| 3. Are you interested in geophysics and
desire Associate Membership in GSH ? |
___ |
Yes |
___ |
No |
If yes, skip items, 5, 6,
and 7 and complete item 8.
- 4. Are you a full-time student applying for Student
Membership?
- Fill in the following blanks
and complete Items 7 and 8
| Academic Major |
__________ |
Expected Graduation
Date & Degree |
___________ |
Click
here for Page 2
|
