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SEG 45 Final_qx4 - Society of Economic Geologists

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46 <strong>SEG</strong> NEWSLETTER No 63 • OCTOBER 2005<br />

–<br />

DUES ARE PAYABLE IN ADVANCE OF JANUARY 1, 2006<br />

[ ]:<br />

Fellow, Member - Standard US$95.00 � <strong>Society</strong> US$_________<br />

Electronic Membership US$75.00 � <strong>SEG</strong> Foundation General Fund US$_________<br />

E-Membership w/ print Newsletter Hugo T. Dummett Fund US$_________<br />

Additional US$10.00 � Alberto Terrones L. Fund US$_________<br />

Couples 2 nd Membership US$25.00 � Timothy Nutt Fund US$_________<br />

Student Membership US$10.00 � Hugh E. McKinstry Fund US$_________<br />

Student Membership w/Print Journal US$50.00 � Hickok-RadfordFund US$_________<br />

**Senior Fellows requesting printed journal US$50.00 � <strong>SEG</strong> Canada Foundation – please refer to page 47<br />

**[Senior Fellows not requesting the journal do not pay dues; to retain membership, please return completed form.]<br />

Honorary and Life Fellows, Post-1972 Lindgren Awardees<br />

[Exempt members must indicate if they wish to receive the journal, ] Initial here: _______<br />

An explanation <strong>of</strong> benefits by membership category for 2006 is detailed on page 47.<br />

to the <strong>Society</strong> (<strong>SEG</strong>) and/or the <strong>SEG</strong> Foundation may be included with the dues payment. Income from invested contributionsis<br />

used to support pr<strong>of</strong>essional activities <strong>of</strong> both organizations. The <strong>SEG</strong> and the <strong>SEG</strong> Foundation are tax-exempt501(c)(3) corporations under U.S.<br />

IRS code. The <strong>SEG</strong> Canada Foundation is a charitable organization registered with the Canada Customs and Revenue Agency.<br />

<strong>SEG</strong> Member Number (from mailing label) ____________ Date:______________________<br />

[circle one]<br />

Mr / Ms / Dr Last Name___________________________________ First Name________________ M. I.____________<br />

�<br />

Company/Institution__________________________________________________________________________________<br />

�<br />

Mailing Address_____________________________________________________________________________________<br />

__________________________________________________________________________________________________<br />

City________________________State/Province_____________Postal Code_____________Country_________________<br />

Phone____________/____________/__________________ Fax____________/____________/__________________<br />

E-mail_____________________________________________________________________________________________<br />

may be made by check (drawn on U.S. bank), money order or credit card in U.S. dollars.<br />

Make checks payable to: <strong>Society</strong> <strong>of</strong> <strong>Economic</strong> <strong>Geologists</strong><br />

American Express � Visa � Mastercard � Discover �<br />

Card No. Expiration Date _______________<br />

Signature________________________________________________________________________<br />

Mail payment to: <strong>Society</strong> <strong>of</strong> <strong>Economic</strong> <strong>Geologists</strong>, Inc.<br />

7811 Shaffer Parkway<br />

Littleton, CO 80127-3732 U.S.A.<br />

FAX: 1.720.981.7874<br />

For <strong>of</strong>fice use only<br />

DB________________________<br />

JRNL______________________<br />

NSL ______________________<br />

__________________________

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