GAC MEMBERSHIP RENEWAL FORM
VOLCANOLOGY & IGNEOUS PETROLOGY DIVISION


Renewal:____________New member:____________(check one)

Please answer the following (circle appropriate item):

I would like the division newsletter, Ashfall, sent to me by E-mail. Yes No

Name: ____________________________________________________________________________
Company: _________________________________________________________________________
Street: ____________________________________________________________________________
City:______________________ Province/State:________________Postal/Zip Code:_____________
Phone ( _______ )____________________________ FAX: ( _______ )________________________
E-Mail: ________________________________ URL: ______________________________________

CATEGORY FEES (includes GST)
GAC or MAC Member $10.00
Student or Senior Free with GAC Membership

Affiliation:__________________________________________________________
Undergraduate: __________________Graduate: _________________ (check one)
Signature of supervisor/dept. chair: ______________________________________

Print and mail completed form and money (cheque or cash) to:

Dr. Pete Hollings [Secretary/Treasurer]
Department of Geology, Lakehead University
955 Oliver Road
Thunder Bay, Ontario, P7B 5E1
Canada
Phone (807) 343 8329 Fax (807) 346 7853
E-mail: peter.hollings@lakeheadu.ca
Make cheques payable to: Volcanology & Igneous Petrology Division - GAC
(receipts issued only upon request)

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