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2009-20010 Membership dues: Regular Member $20, students $5

Please return this form with a check for dues by Oct. 31, 2009 to

Joe Bennett
Treasurer, Potomac Geophysical Society
12 Curtin Pl. SE
Leesburg, VA 20175

Name:

Address:

City, State, ZIP:

Work Phone:
Home Phone:

Email:
FAX:

Professional Affiliation:

Area of Specialization:

Member of SEG? Yes/No AGU? Yes/No

Would you rather receive meeting announcements via E-Mail or Regular Mail (circle one)?

Suggested Topics for Talks and Recommended Speakers:

Would you be interested in speaking? (if yes, what topic?)

What night is most convenient for you to attend PGS?

Where would you prefer the meeting to be held (e.g., Arlington VA, Washington DC, etc.)

How much would you be willing to pay for dinner prior to the PGS talks?

Do you have any suggestions on increasing attendance at meetings?

Name:
Address:
City, State, ZIP:
Work Phone:						Home Phone:
Email:						FAX:
Professional Affiliation:
Area of Specialization:
Member of SEG? Yes/No AGU? Yes/No
Would you rather receive meeting announcements via E-Mail or Regular Mail (circle one)?