ICE2015 Challenge Bowl Registration Form

Incorporating PESA’s Eastern Australasian Basins Symposium International Conference & Exhibition 2015 13-16 September • Melbourne, Australia TEAM MEMBER #1 Name: __________________________________ AAPG or SEG Mbr#: __________________________ Univ.: __________________________________________ Phone: _________________________________ Address: _________________________________________________________________________________ City: _________________________ State: __________________ Postal Code: _____________________ E-mail: ___________________________________________________________________________________ Year of studies: ________________________ Expected grad. Date: __________________________ Degree: ________________________________ Major: ________________________________________ Major: ________________________________________ TEAM MEMBER #2 Name: __________________________________ AAPG or SEG Mbr#: ____________________________ Univ.: __________________________________________ Phone: _________________________________ Address: _________________________________________________________________________________ City: _________________________ State: __________________ Postal Code: _____________________ E-mail: ___________________________________________________________________________________ Year of studies: ________________________ Expected grad. Date: __________________________ Degree: ________________________________ AAPG/SEG Challenge Bowl Registration Form ______________________________________ (AAPG or SEG Student Chapter Name, if applicable) BUSINESS OFFICE: P.O. BOX 979 / TULSA, OK 74101-0979 // Street Address: 1444 S. Boulder Ave. / Tulsa, OK 74119 // Phone: +1 918 560 2617 / Fax: +1 918 560 2684 / Email: [email protected]

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Challenge bowl registration

Transcript of ICE2015 Challenge Bowl Registration Form

Incorporating PESA’s Eastern Australasian Basins Symposium

International Conference& Exhibition 201513-16 September • Melbourne, Australia

TEAM MEMBER #1

Name: __________________________________ AAPG or SEG Mbr#: __________________________

Univ.: __________________________________________ Phone: _________________________________

Address: _________________________________________________________________________________

City: _________________________ State: __________________ Postal Code: _____________________

E-mail: ___________________________________________________________________________________

Year of studies: ________________________ Expected grad. Date: __________________________

Degree: ________________________________ Major: ________________________________________

Major: ________________________________________

TEAM MEMBER #2

Name: __________________________________ AAPG or SEG Mbr#: ____________________________

Univ.: __________________________________________ Phone: _________________________________

Address: _________________________________________________________________________________

City: _________________________ State: __________________ Postal Code: _____________________

E-mail: ___________________________________________________________________________________

Year of studies: ________________________ Expected grad. Date: __________________________

Degree: ________________________________

AAPG/SEG Challenge Bowl Registration Form

______________________________________(AAPG or SEG Student Chapter Name, if applicable)

BUSINESS OFFICE: P.O. BOX 979 / TULSA, OK 74101-0979 // Street Address: 1444 S. Boulder Ave. / Tulsa, OK 74119 // Phone: +1 918 560 2617 / Fax: +1 918 560 2684 / Email: [email protected]