APPLICATION FOR MEMBERSHIP

Any field marked with * is required to complete the form.
 

First Name *
Middle Name
Last Name *
Date of Birth *
Place of Birth 
Nationality *
Type of member *    Membership
Profession *
Professional  Qualification
Designation
Official Address *
E-Mail Address *
Tel No. *
Fax No 
Password *
Confirm Password *
 
DD No *

Membership Charges

Life Member 5000.00
Active Member 500.00        
Honorary Member Free
Student Member 100.00
Associate Member 500.00
Amount *
Date *
Bank Name *

(1) Draft should be in favour of Secretary Association of Petroleum Geologists Dehradun.

(2)  Draft Should be sent to Secretary , Association of Petroleum Geologists 3rd Floor S&T Building, KDMIPE, ONGC 9, Kaulagarh Road, Dehradun-248195, Uttaranchal, India.

You can also deposit Membership Charges in IDBI Bank Account No : 070102000005852

 
Declaration

  I declare that the above particulars supplied by me are correct to the best of my knowledge. I am also fully aware of the fact  that in the event of any information being found incorrect or misleading, my membership will be liable to be cancelled by the Society at any time. 

 


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