Incorporating PESA’s Eastern Australasian Basins Symposium International Conference & Exhibition 2015 13-16 September • Melbourne, Australia TEAM MEMBER #1 Name: __________________________________ AAPG or SEG Mbr#: __________________________ Univ.: __________________________________________ Phone: _________________________________ Address: _________________________________________________________________________________ City: _________________________ State: __________________ Postal Code: _____________________ E-mail: ___________________________________________________________________________________ Year of studies: ________________________ Expected grad. Date: __________________________ Degree: ________________________________ Major: ________________________________________ Major: ________________________________________ TEAM MEMBER #2 Name: __________________________________ AAPG or SEG Mbr#: ____________________________ Univ.: __________________________________________ Phone: _________________________________ Address: _________________________________________________________________________________ City: _________________________ State: __________________ Postal Code: _____________________ E-mail: ___________________________________________________________________________________ Year of studies: ________________________ Expected grad. Date: __________________________ Degree: ________________________________ AAPG/SEG Challenge Bowl Registration Form ______________________________________ (AAPG or SEG Student Chapter Name, if applicable) BUSINESS OFFICE: P.O. BOX 979 / TULSA, OK 74101-0979 // Street Address: 1444 S. Boulder Ave. / Tulsa, OK 74119 // Phone: +1 918 560 2617 / Fax: +1 918 560 2684 / Email: [email protected]
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Feb 05, 2016
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Incorporating PESA’s Eastern Australasian Basins Symposium
International Conference& Exhibition 201513-16 September • Melbourne, Australia
TEAM MEMBER #1
Name: __________________________________ AAPG or SEG Mbr#: __________________________
Univ.: __________________________________________ Phone: _________________________________
Address: _________________________________________________________________________________
City: _________________________ State: __________________ Postal Code: _____________________
E-mail: ___________________________________________________________________________________
Year of studies: ________________________ Expected grad. Date: __________________________
Degree: ________________________________ Major: ________________________________________
Major: ________________________________________
TEAM MEMBER #2
Name: __________________________________ AAPG or SEG Mbr#: ____________________________
Univ.: __________________________________________ Phone: _________________________________
Address: _________________________________________________________________________________
City: _________________________ State: __________________ Postal Code: _____________________
E-mail: ___________________________________________________________________________________
Year of studies: ________________________ Expected grad. Date: __________________________
Degree: ________________________________
AAPG/SEG Challenge Bowl Registration Form
______________________________________(AAPG or SEG Student Chapter Name, if applicable)
BUSINESS OFFICE: P.O. BOX 979 / TULSA, OK 74101-0979 // Street Address: 1444 S. Boulder Ave. / Tulsa, OK 74119 // Phone: +1 918 560 2617 / Fax: +1 918 560 2684 / Email: [email protected]
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