PLEASE COMPLETE AS FULLY AS POSSIBLE! |
pdf versions: download, print and use pen -or- download, fill out with computer, and print |
Single
Membership or Primary Member (for Couples) |
Couple
Membership Second Member with Same Home Address |
||
Member Name | ____________________ |
Member Name | ____________________ |
Position/Title | ____________________ |
Position/Title | ____________________ |
Organization | ____________________ | Organization | ____________________ |
Address | ____________________ | Address | ____________________ |
Address | ____________________ | Address | ____________________ |
City, State, Zip | ____________________ | City, State, Zip | ____________________ |
Office Phone | ____________________ | Office Phone | ____________________ |
Office Fax | ____________________ | Office Fax | ____________________ |
Primary E-Mail | ____________________ | Primary E-Mail | ____________________ |
Alternate E-Mail | ____________________ | Alternate E-Mail | ____________________ |
Home Address | ____________________ | ||
City, State, Zip | ____________________ | ||
Home Phone | ____________________ |
Please
note that ETGS will be waiving membership fees through the 2021 calendar year in
recognition that COVID-19 is impacting our meetings, and because we do not
anticipate as many expenses (meeting rooms, field trips, etc). ETGS would
encourage members to invite friends and colleagues to take advantage of this
rare occasion.
Membership Category | |||
_____ single ($20) | |||
_____ couple ($25) | |||
_____ student ($10) |
Please bring completed form and check (payable to ETGS) to the next meeting, or mail them to
East Tennessee
Geological Society
Post Office Box 6193
Oak Ridge, Tennessee 37831-6193
Revised January 2012
Page updated November 20, 2020 |