DUES RENEWAL/ADDRESS CORRECTION

MINERALS AND GEOTECHNICAL LOGGING SOCIETY

A Chapter at Large of the SPWLA

NAME:
First
Middle Initial
Last

ADDRESS FOR CORRESPONDENCE:

Street

City

State

 

Country

Zip Code

PRESENT EMPLOYMENT: EMAIL ADDRESS:

Company

Street

City

 
State
Please send check for membership dues (preferably drawn on a US Bank) with this form to:
DR. FREDERICK PAILLET
Department of Geological Sciences
111 Bryand Global Sciences Center
University of Maine
Orono, ME 04469-5790
Email: fpaillet@maine.edu

(Print and mail to above address)