Head Office: 12-13-266, Street No.15, Tarnaka, Hyderabad – 500 017, India
Telefax: +91-40-40259557, E-Mail: aegindiageophysics@yahoo.com Web Site : www.aegind.org
Membership Application Form
I, hereby apply for
Life / Student Membership
o f the Association of Exploration Geophysicists.
Please type or write in block letters:
Title
:
(Mr./Ms./Dr./Prof.)
:
Name
:
Designation
:
Organisation
:
Address
:
City & Pin code
:
Country
:
Phone
:
Fax
:
E-mail
:
Mailing Address
:
Qualifications
:
Experience
:
Research Interest
:
Publications
:
Membership of any other Association, Society, Academy, etc
. Attach a separate sheet, if necessary
Sponsor for Life Membership
Name & Designation
:
Organisation
:
Address
:
Member of AEG :
Yes / No
I am satisfied that the applicant is worthy of becoming a Life member of the Association of
Exploration Geophysicists and I recommend the applicant for Life membership.
Date
Signature of Sponsor
Student Membership
Student Applicants must give information on the status and time scale of their studies,
countersigned by their Professor. The duration of Student Membership is valid only till the
period of their study.
Date expected to Graduate
Degree
Signature of Professor
University
Membership Fees
(to be enclosed along with the Application form)
Life Membership
:
Rs. 3,500/- (US$ 350 for Foreign Members)
Student Membership
:
Rs.100/- for admission and Rs.10 as annual
Subscription every year.
Payments are to be made by Demand Drafts drawn in favor of the
Secretary,AEG, Hyderabad.
Details of Bank Account of AEG for sending the amount directly through Electronic Transfer
a. Account Holder Name: Association of Exploration Geophysicists
b. Bank Name: State Bank of Hyderabad, Osmania University Branch, Hyderabad
c. Bank Account of Number: 52198268342
d. MICR Code: 500004044
e. Indian Financial System Code (IFSC) : SBHY0020071
Fee Enclosed
D.D. / Cheque No.
:
Date
:
Amount
:
DECLARATION BY THE APPLICANT
I hereby certify that the information given above is true to the best of my knowledge. I fully
subscribe to the aims and objectives of the AEG and undertake to abide by the rules and
regulations of the Association, in case I am declared a Life Member / Student Member of the
Association.
Date
Signature of Applicant
(FOR OFFICE USE)
The Applicant is Granted/Refused admission to the AEG as a Life Member / Student Member.
Reasons in case of non-admission of the applicant...................................................................................
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