NEW MEMBERSHIP AND UPDATE FORM

For new members or to update existing members please fill out the form and send to:

Randy Kath (rkath@westga.edu)
Department of Geosciences
University of West Georgia
1601 Maple Street
Carrollton, GA 30118.

Name: _________________________________________________________________

Business Affiliation and Address:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Address for mail if other than above:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Telephone Numbers:

Business: _____________________________________________

Home: _______________________________________________

FAX: ________________________________________________

E-mail Address: __________________________________________________________

Have you paid your dues for this year? $5.00__________________________________

Use this space, and the back of the page if necessary, to tell us what you've been up to since we saw you last.