2009-2010 GSM Membership Application
The membership year begins October 1 Questions? Call (612) 724-2101
Name_______________________________________________________ Phone (h) _______________________
Address
_____________________________________________________ Phone (w) ______________________
City________________________________________________
State ___ Zip
____________________________
Email Address__________________________________________________________________________________
Where did you get the GSM info or the stimulus that prompted your membership? __________________________________________
Membership:
Please
mail to:
Please make check payable
to: GSM.
Membership Levels: Geological Society of Minnesota
P.O. Box 390555
(
)
Student …….$10
Edina MN 55439-0555
(
)
Individual …….$20
(
)
Family …….$30
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)
Sustaining …….$50
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)
Supporting ...…$100
( ) Guarantor ..….$250
_____
Membership fee (from left)_____ Media-library membership--add $15 one-time fee
_____ Tax-deductible contribution (GSM is a 501(c)3 nonprofit educational organization)
_____ Total included
Thank you for your membership in the Geological Society of Minnesota.