Geological Society of the Oregon Country

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Name________________________________________________ Spouse____________________________

Children under age 18______________________________________________________

Address __________________________________________  City _____________ State ___ Zip_______-_____

    Phone (_____)_____-__________       Email address__________________________

Geologic Interests and Hobbies_______________________________________________________

_______________________________________________________________________________

Please indicate Membership type and include check for appropriate amount:

Individual $20.00 ___________  Family $30.00 ____________ Student $10.00 _____________

Make Check Payable to: The Geological Society of the Oregon Country
       PO Box 907
       Portland, OR  97207
 
 

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