East Texas Geological Society


For membership information contact Johnnie Wanger at (903) 535-9887 or simply email us at jwanger@sbcglobal.net

Please print this page, fill out the information requested and mail with your Annual Membership Fee.


APPLICATION FOR MEMBERSHIP

Name:______________________ Date: ________________________
Employer:________________________________________________

Preferred Mailing Address: (__) Business (__) Home

Business Address___________________________________________
_____________________________________________________
_____________________________________________________

H
ome Address________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Business Phone:_______________________________________________________________

Home Phone:__________________________________________________________________

Fax:_________________________________________________

E-mail address:_________________________________________

Please send your check for $25.00 annual dues made payable to the
East Texas Geological Society,
102 North College, #612
Tyler, Texas 75702

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