SEG 45 Final_qx4 - Society of Economic Geologists

40 SEG NEWSLETTER No 55 • OCTOBER 2003
2004 Dues Notice – Society of Economic Geologists, Inc.
DUES ARE PAYABLE IN ADVANCE OF JANUARY 1, 2004
Membership
Contributions
Fellow, Member Dues US$85.00 Society US$ _____________
On-line Publications Access additional………US$10.00 SEG Foundation General Fund US$ _____________
Couples 2 nd Membership US$25.00 Hugo T. Dummett Fund US$ _____________
Student Dues (includes on-line access) US$10.00 Alberto Terrones L. Fund US$ _____________
Senior Fellows or Student Members Timothy Nutt Fund US$ _____________
requesting printed journal additional……..US$50.00 Hugh E. McKinstry Fund US$ _____________
Membership Subtotal US$_____ Hickok-Radford Fund US$ _____________
SEG Canada Foundation – see page 41
*Dues Exempt: Life Fellows, Post-1972 Lindgren Awardees Contributions Subtotal US$ _____________
[Exempt members must indicate if they wish to receive the
journal, Economic Geology: initial here:________________ ]
TOTAL ENCLOSED . . . . . . . . . . . . . . . . . . US$ _____________
[Senior Fellows not requesting the journal do not pay dues; to retain membership, please return completed form.]
An explanation of benefits by membership category for 2004 is detailed on the website at: www/segweb.org/membership.htm
CONTRIBUTIONS to the Society (SEG) and/or the SEG Foundation may be included with the dues payment. Income from invested contributions
is used to support professional activities of both organizations. The SEG and the SEG Foundation are tax-exempt 501(c)(3) corporations under
U.S. IRS code. The SEG Canada Foundation is a charitable organization registered with the Canada Customs and Revenue Agency.
SEG Member Number (from mailing label) __________________________
Date: _____________________________
[circle one]
Mr / Ms / Dr Last Name ________________________________________ First Name___________________________ M. I.______________
NO CHANGES FROM CURRENT MAILING LABEL
Company/Institution _____________________________________________________________________________________________________
DO NOT INCLUDE COMPANY/INSTITUTION NAME ON MAILING LABEL
Mailing Address _________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
City _____________________________ State/Province _______________ Postal Code_________________ Country_____________________
Phone _______________/ ________________/ ________________ Fax _________________/ _________________/ ________________
Country Code City/Area Code Phone Number Country Code City/Area Code Phone Number
E-mail __________________________________________________________________________________________________________________
PAYMENT may be made by check (drawn on U.S. bank), money order or credit card in U.S. dollars.
Make checks payable to: Society of Economic Geologists
American Express Visa Mastercard Discover
Card No. _______________________________________________________Expiration Date ____________________
Signature__________________________________________________________________________________________
VOLUNTEERS: SEG depends on volunteers from its membership to serve on committees.
Please indicate on which committee(s) you would like to serve: __________________________________________________________________
Mail payment to:
Society of Economic Geologists, Inc.
7811 Shaffer Parkway
Littleton, CO 80127 U.S.A.
FAX: 1.720.981.7874
For office use only
DB_________________________________
JRNL_______________________________
NSL________________________________
SEG No ____________________________