I wish to apply for full membership of the Dorset GA Group.
I enclose subs of £12.00 (£9.00 student)
newsletter only £7.50
delete those not required and make cheque out to 'Dorset GA'.

Signed:                                                           Date:

Name and Address (block capitals)                      Telephone: (including code)

email address:

I am/am not* a paid up member of the GA(*delete where necessary)

What aspect of geology interests you? (please tick as many as you care to)

Igneous rocks                                                           Sedimentary rocks
Palaeontology                                                          Tectonics
Environment                                                             Structural geology
Palaeobiology                                                          Geomorphology
Economic Resources                                              Astronomy
Any Other(please specify)

Your personal details given on this form will be held in a computer system which will be used for administrative purposes.  The details will be included in the name and address list distributed to all members to encourage interaction between like minds unless you instruct otherwise.

Please send the completed form with your subscription to the Hon Treasurer:

Mrs Alison Neil 15 Littlemoor Road Weymouth Dorset DT3 6LA
Membership Application Form