5. Please provide details of your professional experience as stated in Item 2a.
If you require additional space, please attach a separate page.

 Dates:
from to
(mo/yr) (mo/yr)
 Employer: Name
Street, City, State

 Specific Description of your Work and/or Teaching Experience
     
     
     
     

6. Please provide details of your college work as stated in Item 2b.
If you require additional space, please attach a separate page.

  Dates
from to
(mo/yr) (mo/yr)
University or College
City, State

 Major

 Degree Obtained
 Date Degree Completed
         
         
         
         

7. Applicants for Active Membership, who are not currently Active Members of the Society of Exploration Geophysicists, must provide the name of one sponsor who is currently an Active Member of GSH.
Applicants for Associate Membership do not require a sponsor. Applicants for Student Membership must provide the name of a school administrator or faculty member who can certify as to their being a full-time student. You may call the GSH office at 713-463-9476 for names of Active GSH members in your company or organization.

Sponsor or School Representative
 Name
Address: Street, City, State
 Telephone
 _____________________________ ___________________________  

8. I hereby state that, to the best of my knowledge, the information and statements contained in this application are true.

________________________________________________

Applicant's Signature

Application received ________By_________________Dues Paid___________Notified by____________________

NOTE: Both parts of this application must be completed.

Please attach a check or money order ($25.00 for Active and Associate applicants, $12.00 for Student and Emeritus applicants) to your completed application and mail it to Membership Chairman, Geophysical Society of Houston, 10575 Katy Freeway, Suite 290, Houston, Texas 77024. All information is subject to verification. Applicants for Active Membership will be granted Associate Membership status pending review by the GSH Membership Committee. Applications must be approved by the Geophysical Society of Houston's Board of Directors.

Credit Card Account Number: (MC, VISA, or AMEX only: Circle One)

         --          --          --        
Expiration Date: _______________