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AAPG Application
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8/6/2019 AAPG Application http://slidepdf.com/reader/full/aapg-application 1/2 AAPG STUDENT MEMBERSHIP The American Association of Petroleum Geologists, Inc. An International Geological Organization P.O. Box 979, Tulsa, Oklahoma 74101-0979 USA • Phone: (918) 560-2653 • Fax: (918) 560-2694 e-mail: [email protected] • Web site: http://www.aapg.org PLEASE PRINT CLEARLY AND ATTACH COPY OF YOUR STUDENT I.D. STATEMENT OF COLLEGE WORK DATES INDICATE From To COLLEGE OR UNIVERSITY MAJOR FIELD Month / Year Month / Year (No abbreviations.) OF STUDY Expected Date of Degree: BS_________________________________ MS__________________________________ PhD______________________________ (or international equivalent) K Mr. K Ms. K Miss K Mrs. K Male. K Female __________________________________________________________________________________________________________ Last Name First Middle Mailing Address_____________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ City State/Province Zip Country Phone (______) _____________-_________________________________ Fax (______) _______________- __________________________________ E-mail address: ___________________________________________ ______________________________________ ____________________________ Date of Birth_____________________ Place______________________________________ Citizenship______________________________________ MEMBERSHIP QUALIFICATIONS FOR STUDENTS (Bylaws, Article I) – SECTION 7. Students Any student majoring in geology or in a field of study related to or generally associated with geology at a college of acceptable academic standards may apply for Student membership. Student membership shall terminate upon termination of academic enrollment; however, member is automatically advanced to Associate class. AAPG members are expected to adhere to the Code of Ethics. The Constitution, which includes the Code of Ethics, and Bylaws are accessible on the AAPG website at: www.aapg.org . FOR AAPG USE Received_________________________ Notified__________________________________ Applicant Must Provide Name AND Email of Faculty Sponsor/Advisor: Name: ___________________________________________________ (PRINT OR TYPE) Email:____________________________________________________ Chevron Corporation is the corporate sponsor of AAPG’s Corporate Sponsorship Program. Under this program Chevron will pay the dues of any AAPG Student member if the Student member so elects. Information about you contained in AAPG’s records may be sent by AAPG to Chevron if you elect to have Chevron pay your dues under the Program. To elect to have Chevron pay your AAPG Student membership dues under the Corporate Sponsorship Program, please check the “yes” box below. If you do not elect to have corporate sponsorship, please check “no” and include payment. Corporate Sponsorship dues need to be requested each year. K Yes, I wish that Chevron pay my AAPG Student membership dues under the Corporate Sponsorship Program. I understand and agree that information about me contained in AAPG’s records may be sent by AAPG to Chevron for use as determined solely by Chevron, and I hereby authorize AAPG to provide such information to Chevron. K No, my payment will accompany this application. See reverse side. Signature of Applicant ________________________________________ Date ___________________________________________ GHOSAL ARNAB 61/A, Jaffarpur Road, Barrackpore Kolkata West Bengal 700122 India +918757647627 [email protected] 25 September, 1989 24 Parganas North Indian 07/2007 Present Indian School of Mines Applied Geophysics 07/2007 Present Indian School of Mines Applied Geophysics 31 May, 2012 Dr. MRINAL K. MUKHERJEE [email protected] Arnab Ghosal 18 February, 2011 Mr.
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Transcript of AAPG Application
8/6/2019 AAPG Application
http://slidepdf.com/reader/full/aapg-application 1/2
AAPG STUDENT MEMBERSHIPThe American Association of Petroleum Geologists, Inc.
An International Geological OrganizationP.O. Box 979, Tulsa, Oklahoma 74101-0979 USA • Phone: (918) 560-2653 • Fax: (918) 560-2694
e-mail: [email protected] • Web site: http://www.aapg.org
PLEASE PRINT CLEARLY AND ATTACH COPY OF YOUR STUDENT I.D.
STATEMENT OF COLLEGE WORK
DATES INDICATEFrom To COLLEGE OR UNIVERSITY MAJOR FIELD
Month / Year Month / Year (No abbreviations.) OF STUDY
Expected Date of Degree: BS_________________________________ MS__________________________________ PhD ______________________________(or international equivalent)
KMr. KMs. KMiss KMrs.
K Male. K Female __________________________________________________________________________________________________________Last Name First Middle
Mailing Address_____________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________City State/Province Zip Country
Phone (______) _____________-_________________________________ Fax (______) _______________- __________________________________
E-mail address: _____________________________________________________________________________________________________________
Date of Birth_____________________ Place______________________________________ Citizenship______________________________________
MEMBERSHIP QUALIFICATIONS FOR STUDENTS (Bylaws, Article I) – SECTION 7. StudentsAny student majoring in geology or in a field of study related to or generally associated withgeology at a college of acceptable academic standards may apply for Student membership. Studentmembership shall terminate upon termination of academic enrollment; however,
member is automatically advanced to Associate class.AAPG members are expected to adhere to the Code of Ethics. The Constitution, which includes theCode of Ethics, and Bylaws are accessible on the AAPG website at: www.aapg.org.
FOR AAPG USE
Received_________________________ Notified__________________________________
Applicant Must Provide Name AND Email of Faculty Sponsor/Advisor: Name: ___________________________________________________
(PRINT OR TYPE)Email:____________________________________________________
Chevron Corporation is the corporate sponsor of AAPG’s Corporate Sponsorship Program. Under this programChevron will pay the dues of any AAPG Student member if the Student member so elects. Information about you containedin AAPG’s records may be sent by AAPG to Chevron if you elect to have Chevron pay your dues under the Program.
To elect to have Chevron pay your AAPG Student membership dues under the Corporate SponsorshipProgram, please check the “yes” box below.
If you do not elect to have corporate sponsorship, please check “no” and include payment.
Corporate Sponsorship dues need to be requested each year.
K Yes, I wish that Chevron pay my AAPG Student membership dues under the Corporate Sponsorship Program. Iunderstand and agree that information about me contained in AAPG’s records may be sent by AAPG to Chevron for use as determinedsolely by Chevron, and I hereby authorize AAPG to provide such information to Chevron.
K No, my payment will accompany this application. See reverse side.
Signature of Applicant ________________________________________ Date ___________________________________________
GHOSAL ARNAB
61/A, Jaffarpur Road, Barrackpore
Kolkata West Bengal 700122 India
+918757647627
25 September, 1989 24 Parganas North Indian
07/2007 Present Indian School of Mines Applied Geophysics
07/2007 Present Indian School of Mines Applied Geophysics
31 May, 2012
Dr. MRINAL K. MUKHERJEE
Arnab Ghosal 18 February, 2011
Mr.
8/6/2019 AAPG Application
http://slidepdf.com/reader/full/aapg-application 2/2
DUES INCLUDE subscription to the AAPG EXPLORER ($1.25) and online subscription to the AAPG BULLETIN (6.25).Do not pay these amounts
06
Energy Minerals Division serves geologists
involved in non-petroleum energy resources, including
coal, coalbed methane, geothermal, oil and gas shales,
and tar sands, and geologists using remote sensing
technologies in their work.
K YES I wish to join the EMD.
Division of Environmental Geosciences furthersthe Association’s commitment to protect the environmentwhile developing natural resources in a responsiblemanner.
K YES I wish to join the DEG. With Journal (online digital format)
Mail or Fax completed membership form along with payment to:
AAPG Membership Department Fax: 918-560-2694P.O. Box 979 Phone: 918-584-2555Tulsa, Oklahoma 74101-0979, USA 1-800-364-2274 (U.S. & Canada)
Useful links:Student Chapter Page: http://students.aapg.org/
Grants-In-Aid: http://foundation.aapg.org/ AAPG Meetings: http://www.aapg.org/meetings/
Student Expo: http://www.studentexpo.info/ Education programs: http://www.aapg.org/education/
Payment must be one of the following methods.1. Check or Draft – drawn in U.S. Dollars on a
bank located in the United States (usuallyone can obtain such a check or draft from alocal bank).
2. Direct Bank Transfer –To arrange a bank transfer please contactAAPG at +1 800 364-2274 (toll free U.S. &Canada) or +1 918 584-2555.
3. International Postal Money Order.4. Credit Card.
Dues payments to AAPG are not a charitable
contribution for U.S. income tax purposes;however, membership dues are deductible formany members as an ordinary and necessarybusiness expense.
To pay by credit card, complete the information below.KMaster Card K Visa KAmerican Express
(16 numbers) (13 or 16 numbers) (15 numbers)
K Discover K Diners Club(16 numbers) (14 numbers)
Name of
Cardholder (print): _____________________________________________________________
Card Number: _____________________________________ Expiration Date: ____________
Amount of Paymentin U.S. Dollars: ________________________________________________________________$
Signature: ___________________________________________ Date: ____________________
Notice: As a Student Member you will have Internet access and (a yearly CD-ROM) to the AAPG BULLETIN . Other benefits include the AAPGEXPLORER, book discounts, and a special student rate for short courses.
STUDENT MEMBERSHIP DUESNorth America – $10.00 Outside North America – $20.00*
*Includes a mailing surcharge of $10.00 for addresses outside North Ameri
• AAPG operates on a fiscal year: July 1 – June 30. •
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