AAPG STUDENT MEMBERSHIP

The American Association of Petroleum Geologists, Inc. An International Geological Organization
P.O. Box 979, Tulsa, Oklahoma 74101-0979 USA • Phone: (918) 560-2653 • Fax: (918) 560-2694 e-mail: students@aapg.org • Web site: http://www.aapg.org

MEMBERSHIP QUALIFICATIONS FOR STUDENTS (Bylaws, Article I) – SECTION 7. Students Any student majoring in geology or in a field of study related to or generally associated with geology at a college of acceptable academic standards may apply for Student membership. Student membership shall terminate upon termination of academic enrollment; however, member is automatically advanced to Associate class.
AAPG members are expected to adhere to the Code of Ethics. The Constitution, which includes the Code of Ethics, and Bylaws are accessible on the AAPG website at: www.aapg.org.

Mr. K Ms. K Miss K Mrs. K Mr.

PLEASE PRINT CLEARLY AND ATTACH COPY OF YOUR STUDENT I.D.

ARNAB K Male. K Female GHOSAL ____________________________________________________________________________________________________________
Last Name First Middle

61/A, Jaffarpur Road, Barrackpore Mailing Address_______________________________________________________________________________________________________________
Kolkata West Bengal 700122 India ____________________________________________________________________________________________________________________________
City State/Province Zip Country

+918757647627 Phone (______) _____________-_________________________________ Fax (______) _______________- ____________________________________
E-mail address: arnabghosal1989@gmail.com _______________________________________________________________________________________________________________

25 September, 1989 24 Parganas North Indian Date of Birth_____________________ Place______________________________________ Citizenship ________________________________________

STATEMENT OF COLLEGE WORK
DATES From To Month / Year Month / Year COLLEGE OR UNIVERSITY (No abbreviations.) INDICATE MAJOR FIELD OF STUDY

07/2007 Present Indian School of Mines 07/2007 Present Indian School of Mines
Expected Date of Degree:

Applied Geophysics Applied Geophysics

BS_________________________________ MS__________________________________ PhD ________________________________
(or international equivalent)

31 May, 2012

Applicant Must Provide Name AND Email of Faculty Sponsor/Advisor: (PRINT OR TYPE)

Name: Dr. MRINAL K. MUKHERJEE _____________________________________________________

mrinal_km67@yahoo.co.in Email:______________________________________________________

K Yes, I wish that Chevron pay my AAPG Student membership dues under the Corporate Sponsorship Program. I understand and agree that information about me contained in AAPG’s records may be sent by AAPG to Chevron for use as determined solely by Chevron, and I hereby authorize AAPG to provide such information to Chevron. K No, my payment will accompany this application. See reverse side.

Chevron Corporation is the corporate sponsor of AAPG’s Corporate Sponsorship Program. Under this program Chevron will pay the dues of any AAPG Student member if the Student member so elects. Information about you contained in AAPG’s records may be sent by AAPG to Chevron if you elect to have Chevron pay your dues under the Program.  To elect to have Chevron pay your AAPG Student membership dues under the Corporate Sponsorship Program, please check the “yes” box below.  If you do not elect to have corporate sponsorship, please check “no” and include payment.  Corporate Sponsorship dues need to be requested each year.

Signature of Applicant ________________________________________ Date _____________________________________________ FOR AAPG USE
Received_________________________ Notified____________________________________

Arnab Ghosal

18 February, 2011

S.25).org/education/ Notice: As a Student Member you will have Internet access and (a yearly CD-ROM) to the AAPG BULLETIN. Oklahoma 74101-0979. International Postal Money Order.info/ Education programs: http://www. including coal.org Fax: 918-560-2694 Phone: 918-584-2555 1-800-364-2274 (U. and geologists using remote sensing technologies in their work.org/ Grants-In-Aid: http://foundation. Check or Draft – drawn in U. membership dues are deductible for many members as an ordinary and necessary business expense. however. and a special student rate for short courses. IS IO N (16 numbers) C K Visa (13 or 16 numbers) K Diners Club (14 numbers) K American Express (15 numbers) . DUES INCLUDE subscription to the AAPG EXPLORER ($1. K YES I wish to join the DEG. 1. Credit Card.Useful links: Student Chapter Page: http://students.aapg.00 for addresses outside North America K YES I wish to join the EMD. To pay by credit card. Direct Bank Transfer – To arrange a bank transfer please contact AAPG at +1 800 364-2274 (toll free U.aapg. With Journal (online digital format) AAPG Payment must be one of the following methods. 2. coalbed methane.studentexpo. Signature: ___________________________________________ Date: _____________________ Mail or Fax completed membership form along with payment to: AAPG Membership Department P. & Canada) Print Document then Fax. & Canada) or +1 918 584-2555. complete the information below.00 STUDENT MEMBERSHIP DUES • AAPG operates on a fiscal year: July 1 – June 30. V OF E N IR O N M E N TA L GE O SCIE N Division of Environmental Geosciences furthers the Association’s commitment to protect the environment while developing natural resources in a responsible manner. North America – $10.S. and tar sands. Box 979 Tulsa. Other benefits include the AAPG EXPLORER.25) and online subscription to the AAPG BULLETIN (6. book discounts.00* *Includes a mailing surcharge of $10.S. geothermal. K Master Card (16 numbers) K Discover Name of Cardholder (print): ______________________________________________________________ Card Number: _____________________________________ Expiration Date: _____________ Amount of Payment in U. income tax purposes.org/meetings/ Student Expo: http://www.S. Dollars on a bank located in the United States (usually one can obtain such a check or draft from a local bank). 3. oil and gas shales.org/ AAPG Meetings: http://www.O. Dollars: _________________________________________________________________ $ Dues payments to AAPG are not a charitable contribution for U.aapg. • Outside North America – $20. 4. USA Click to Email data to students@aapg.S.aapg. Do not pay these amounts 06/10 ES DI V Energy Minerals Division serves geologists involved in non-petroleum energy resources.

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