Please print off this page, complete and send together with your fee to the membership secretary.

North Staffordshire Group Geologists' Assocation Membership Details

NSGGA MEMBERSHIP APPLICATION

Name:

Address:

Tel.

e-mail:

Would you be willing to receive your Bulletins by e-mail? Yes/No

Subscription Rates

[ ] Ordinary (Full) £13.00

[ ] Family * £15.00

[ ] Unemployed / Retired £10.00

[ ] Full-time Student ** £3.00

 * For insurance purposes, please list the names of all members of the household to be included

 ** Students please name your full-time course

 John Myers Award Fund contribution of £

Cheques should be made payable to the
"North Staffordshire Group of the Geologists' Association" or "NSGGA"

and sent to

Mike Brown, NSGGA Membership Secretary,
6 Spring Close,
Rode Heath,
Stoke-on-Trent
ST7 3TQ

Tel. 01270 878130 E-mail: michael.a.brown@lineone.net

For our records, we would like to know if you are currently a member of the national GA ? yes / no