Membership type (circle one)         Regular         Student

Telephone:                                                    Fax:                                                   

E-mail:                                                                                                     

Membership dues are $25 ($10 Students) / year (fiscal year starts May 1st)

Amount enclosed:                                 Make cheque payable to: CSCOP

Signature:                                                                                  Date:                               

Mail to: 

Andrew Beaton Alberta Geological Survey 4th floor, Twin Atria Building 4999-98 Avenue Edmonton AB T6B 2X3

Phone: 780-427-0809 Fax:     780-422-1459 Email: Andrew.Beaton@gov.ab.ca

Instructions: