AAPG/SEG Challenge Bowl Registration Form

International Conference
& Exhibition 2015

______________________________________

13-16 September Melbourne, Australia

(AAPG or SEG Student Chapter Name, if applicable)

Incorporating PESAs Eastern

Australasian Basins Symposium

TEAM MEMBER #1
Name: __________________________________ AAPG or SEG Mbr#: __________________________
Univ.: __________________________________________ Phone: _________________________________
Address: _________________________________________________________________________________
City: _________________________ State: __________________ Postal Code: _____________________
E-mail: ___________________________________________________________________________________
Year of studies: ________________________

Expected grad. Date: __________________________

Degree: ________________________________

Major: ________________________________________

TEAM MEMBER #2
Name: __________________________________ AAPG or SEG Mbr#: ____________________________
Univ.: __________________________________________

Phone: _________________________________

Address: _________________________________________________________________________________
City: _________________________ State: __________________ Postal Code: _____________________
E-mail: ___________________________________________________________________________________
Year of studies: ________________________

Expected grad. Date: __________________________

Degree: ________________________________

Major: ________________________________________

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