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