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

Gerald Ford,, NSGGA Membership Secretary, 
Woodville, Tower Road, Ashley Heath, Market Drayton, Shropshire TF9 4PU

Tel. 01630 673409
e-mail: g.ford@btinternet.com    

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