Name_______________________________________________________ Phone (H) _______________________ 

Address _____________________________________________________ Phone (C) ______________________ 

City_______________________________________________ State _______ Zip _________________________ 

Email Address(es)_____________________________________________________________________________

Where did you get the GSM info or the stimulus that prompted your membership?

__________________________________________________________________________________________________ 
 

Membership:  Please make check payable to: GSM

Please mail to:

Geological Society of Minnesota

P.O. Box 141065

Minneapolis, MN 55414-6055

Membership Levels:
             ( ) Student     _____$10
             ( ) Individual  _____$20;   $40 (2 years);   $60 (3 years)
             ( ) Family        _____$30;   $60 (2 years);   $90 (3 years)
             ( ) 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)

                                               _____ Check here if you want a contribution receipt for tax-filing purposes.

                                  _____ Total included                      

Thank you for your membership in the Geological Society of Minnesota.