Association of Petroleum Geologists

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.