EAST TENNESSEE GEOLOGICAL SOCIETY

ETGS Membership Information

PLEASE COMPLETE AS FULLY AS POSSIBLE!
pdf versions: download, print and use pen  -or-  download, fill out with computer, and print

 

Single Membership
or Primary Member (for Couples)
Couple Membership
Second Member with Same
Home Address
Member Name

____________________

Member Name ____________________
Position/Title

____________________

Position/Title ____________________
Organization ____________________ Organization ____________________
Address ____________________ Address ____________________
Address ____________________ Address ____________________
City, State, Zip ____________________ City, State, Zip ____________________
Office Phone ____________________ Office Phone ____________________
Office Fax ____________________ Office Fax ____________________
Primary E-Mail ____________________ Primary E-Mail ____________________
Alternate E-Mail ____________________ Alternate E-Mail ____________________
Home Address ____________________    
City, State, Zip ____________________    
Home Phone ____________________    

   

Membership Category  
  _____ single ($20)    
  _____ couple ($25)    
  _____ student ($10)    

Please bring completed form and check (payable to ETGS) to the next meeting, or mail them to

ETGS
c/o Seaira Stephenson
105 Amanda Dr

Oak Ridge, Tennessee 37830-7813

Revised January 2024


 

Page updated January 18, 2024