Membership
Application Form
New Member: o Renewal: o
Date: __________
Please
fill in as much of the details as you feel free to. The boxes marked ‘*’ must be filled in.
Personal Details:
*Full Name: _________________________________________
*Male: o Female: o
Year of Birth:_____________________
*Company: _________________________________________
*Occupation / Job Title________________________________
Year Graduated:______________ Institution:______________
Qualifications: BSc o MSc o PhD o Other _________
Nationality:__________________________________________
Contact Details:
Phone
(Office):_______________________________________
*Phone (
*E-mail:____________________________________________
(We
will send your newsletter to this address – please let us know if it changes)
Professional
memberships:
Are you a member of any
other Geological Societies?
Please check below:
AAPG: o
Since_________ PESGB:
o Since______________
Other: o _________________Since____________________
Is
there anything else you would like us to know about your membership?
___________________________________________________________
I have
paid my QAR 50 fee for this calendar year o, or
I am a student and so exempt from QGS
fees o
I hereby accept to abide by the
Constitution and Bylaws and Code of Ethics of The
Signature: ______________________ Date: _____________________