Tulsa Geological Society Membership Renewal

Name:__________________________________

Company:_______________________________ Position or Title:_________________

Co. Address:________________________________City:____________St:_____Zip:______

Company Phone:_________________

Home Address:__________________________City:____________St:_____Zip:_________

Home Phone:___________________

E-mail:____________________________


Preferred Mailing Address: __Home __Office

Dues: $25 Active Members, $12 Emeritus Members, $5 Student Members


Please Return to :
Tulsa Geological Society
4308 S. Peoria, Box 602
Tulsa, OK 74105