Instructions: To facilitate becoming a member , it is imperative that the instructions within the application are followed explicitly and all of the required information is provided at the time of the initial submission. Failure to do so will result in the application being returned and approval being delayed.

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Name: _____________________________________ Date: ______________

Address: _______________________________________________________
              Street                     Apt#         City            State       Zip

Telephone: (____) _______________

Employer: (or school if you are a student) _________________________________

Business Address: _____________________________________________________
                           Street (or P.O. Box #)               City            State       Zip

Company Phone: (____) _______________ Ext. # ____ Fax# : (____) _______________

Job Title: ____________________________________

Email Address: __________________________

I prefer to receive GSH mail at my _____ home address _____ business address (optional)

Spouses Name: _____________________________

Interested in Joining GSH Auxiliary? _____ yes _____ no

Membership Qualifications

1. Are you currently a member of the Society of Exploration Geophysicists?

_____yes _____ no

Check membership classification below and enclose copy of current SEG membership
card with this application.

Active _____ Associate _____ Student ______

If requesting same classification of GSH membership, skip Items 2 through 7 and complete Item 8.

2. If you are not an SEG member or are applying for an upgraded GSH membership, are you now engaged in practicing or teaching geophysics or related science?

_____ yes _____ no

2a. How many years of practicing or teaching? _______________________

If your total years of experience is 8 or greater, and you are applying for Active Membership, skip Items 3 and 4 and complete Items 5, 6, 7, and 8.

3. Are you interested in geophysics and desire Associate Membership in GSH?

_____ yes _____ no

If yes, skip items, 5, 6, and 7 and complete item 8 . 4. Are you a full-time student applying for Student Membership? Fill in the following blanks and complete
items 7 and 8.

Academic Major: ____________________________

Expected Graduate Date & Degree: ________________________________

4. Please provide details of your professional experience as stated in Item 2a.
If you require additional space, please attach a separate page.

5. Please provide details of your college work as stated in Item 2b.
If you require additional space, please attach a separate page.

6. Applicants for Active Membership, who are not currently Active Members of the Society of Exploration Geophysicists, must provide the name of one sponsor who is currently an Active Member of GSH. Applicants for Associate Membership do not require a sponsor. Applicants for Student Membership must provide the name of a school administrator or faculty member who can certify as to their being a full-time student. You may call the GSH office at 713-463-9476 for names of Active GSH members in your company or organization.

Sponsor or School Representative

7. I hereby state that, to the best of my knowledge, the information and statements contained in this application are true.

Applicant's Signature ________________________________________________

Application received ________By_________________Dues Paid___________

Notified by________________________

NOTE: Both parts of this application must be completed.

Please attach a check or money order ( $25.00 for Active and Associate applicants, $12.00 for Student and Emeritus applicants) to your completed application and mail it to Membership Chairman, Geophysical Society of Houston, 10575 Katy Freeway, Suite 290, Houston, Texas 77024. All information is subject to verification. Applicants for Active Membership will be granted Associate Membership status pending review by the GSH Membership Committee. Applications must be approved by the Geophysical Society of Houston's Board of Directors.

Credit Card Account Number: (MC, VISA, or AMEX only: Circle One)

__ __ __ __ -- __ __ __ __ -- __ __ __ __ -- __ __ __ __

Expiration Date: _____________

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