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.
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
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
