2011-2012 membership year begins October 1 Questions? Call (612) 724-2101
Name_______________________________________________________ Phone (h) _______________________
Address _____________________________________________________ Phone (w) ______________________
City________________________________________________ State ___ Zip ____________________________
Email Address__________________________________________________________________________________
Where did you get the GSM info or the stimulus that prompted your membership? __________________________________________
Would you like to help GSM save money (and trees) and receive our quarterly newsletter only by email? ( ) Yes ( ) No
Membership: Please mail to:
Please make check payable to: GSM.
Membership Levels: Geological Society of Minnesota
P.O. Box 390555
( ) Student _____$10 Edina MN 55439-0555
( ) Individual _____$20
( ) Family _____$30
( ) Sustaining _____$50
( ) Supporting _____$100
( ) Guarantor _____$250
_____ Membership fee (from above)
_____ Media-library membership--add $15 one-time fee
_____ Tax-deductible contribution (GSM is a 501(c)3 nonprofit educational organization)
_____ Total included
Thank you for your membership in the Geological Society of Minnesota.
PDF version