SGA
Society for Geology Applied to Mineral Deposits

MEMBERSHIP APPLICATION FORM
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I would like to become a member of the Society for Geology Applied to Mineral Deposits and to receive my personal copy of Mineralium Deposita. Membership fees will be due after acceptance of the membership application by the SGA Council. 

Surname / Corporation:

First name:

Title:

Mailing address:

 

 

Phone:

Fax:

e-mail:

Date of birth:

Nationality:

Academic degrees obtained:

Present position:

Membership in other scientific societies:

Are you a member of the Society of Economic Geologists?

Yes

No (If yes, no sponsors are necessary)

 

 

65.00 EUR Regular Member

10.00 EUR Student Member (max. 4 years, up to Ph.D.)*

45.00 EUR Senior Member (after retirement)*   *Certificate required

200.00 EUR Corporate Member (includes 3 copies of Mineralium Deposita)
                   (for industry only, no academic institutions)

If the application is approved by the SGA Council, I authorize the "Society for Geology Applied to Mineral Deposits" to charge the above amount (please tick) to my

VISA

MASTERCARD/EUROCARD

AMERICAN EXPRESS

Card No.

Expiry Date

Signature ...................................................  Place and date ................................................................
(if you do not intend to pay by credit card, an invoice will be issued after acceptance of your application)
Two SGA Sponsors*:
                      Name                      Place                       Date                      Signature 

1. ______________________________________________________________________________

2. ______________________________________________________________________________
*If you have difficulty in finding sponsors, send this form to the Executive Secretary and your application will still be considered.

Send the Membership Application Form to:

 

 

Dr. Jan Pasava

 

 

SGA Executive Secretary

 

 

Czech Geological Survey

phone: 

++(420)-2-51085506

Klárov 131/3

fax: 

++(420)-2-51818748

CZ-118 21 Praha 1

e-mail: 

pasava@cgu.cz

CZECH REPUBLIC