Affiliation of Christian Geologists
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Membership Application Form

Note: You will be asked to print and mail this form once you have filled it out. If any of your responses don't fit completely in the boxes, they may not visible when they are printed. Please complete them by hand after printing.

Name
Date of Birth
Sex Male   Female
Home Address
Home Phone
Office Address
Office Phone
E-mail address
Spouse's name, if married
Children

Do you wish mailings sent to your home or office?
Home   Office

Do you wish your phone number published in a membership directory?
Yes   No

Academic Preparation

College or University Degree Year Major
1.
2.
3.

Fields of Professional Experience and Interest

Recent Publications (attach Vita if you wish)

Professional Organizations

Do you commonly attend the national meetings of any professional societies?
Geological Society of America
American Association of Petroleum Geologists
American Geophysical Union - Fall   Spring
Other

Would you be interested in attending a meeting of the Affiliation of Christian Geologists held in conjunction with any of these national meetings?
Yes   No

Are you a member of the American Scientific Affiliation?
Yes   No

Please consider my application for membership in the affiliation of Christian Geologists as a Regular , Student , or Associate   Member. I am in agreement with the statements of Purpose and Principles.

Signed:

Date:

Amount Enclosed ($10 yearly dues):

Please print this form (approximately 3 pages) and send dues and application to:
ACG c/o Keith B. Miller
Dept of Geology, Kansas State University
Manhattan, KS, 66506-3201


Affiliation Business | Educational Resources
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