APPLICATION FOR STUDENT MEMBERSHIP SOCIETY OF PETROLEUM GEOPHYSICISTS (REGD.) 1, OLD CSD Building, KDMIPE Campus Kaulagarh Road, Dehradun- 248195 Tel: 91-135-2795536/2752088 Fax: 91-135-2752088 Email:
[email protected] Website: www.spgindia.org
1. Membership No
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2. Mr./Ms
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3. Mailing Address : -------------------------------------------------------------------------------Phone(……………………) -------------------------------------------------------------------------------Fax(………………………) 4. Email Address
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5. Date of Birth
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6. State of College Work EXPECTED DATE OF GRADUATION / POST GRADUATION
COLLEGE OR UNIVERSITY (GIVE ADDRESS NO ABBREVIATIONS
INDICATE MAJOR FIELD OF STUDY
7. Signature of Faculty (Required):---------------------------------Faculty Title:---------------------------
8. Subscription Details
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Free Membership
Date……………………… Signature of Applicant Place…………………….
GENERAL INSTRUCTIONS 1. The information should be filled neatly 2. Duly filled application form should be sent to Secretary, SPG, India, 1, Old CSD Building, KDMIPE Campus, Kaulagarh Road, Dehradun – 248195, Uttaranchal, India
