Affiliation:    ___________________________________________________

Address:     ___________________________________________________ 

Sponsoring member(s):                                                                                                                                                                

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

Covers years:  03/04    04/05    05/06    06/07   07/08   (please indicate years covered by payment)
 

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: