Membership Renewal Form

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)