STUDENT MEMBERSHIP APPLICATION FORM

Online registration also available (www.eage.org)

CONDITIONS FOR STUDENT MEMBERSHIP

Student applicants must not be older than 34 years of age (when applying)
Students must be registered in a full time study programme at a recognized university or institute
The student membership application must be accompanied by a copy of a student ID card and/or official proof of enrollment.
Membership is on a calendar year basis. Applications received in October, November and December will be considered for the
next calendar year.
At the completion of his/her study a student member may convert his/her student membership to regular EAGE membership

YOUR PERSONAL DETAILS

Miss

Mr

Mrs

Ms

Surname
First name

Initials

Date of birth (dd/mm/yyyy)

PRIVATE ADDRESS
Address
Postal Code

City

Country
Tel.

UNIVERSITY DETAILS
Name of University
Address
Department

Tel.

Postal Code

City

Country
In order to receive your First Break copy every month, please indicate your preferred postal address:
University address
Private address

E-MAIL DETAILS
Private e-mail
Personal university e-mail
Preferred e-mail address:
University e-mail

Private e-mail

CURRENT EDUCATIONAL STATUS

Date expected to graduate of your current education (mm/yyyy)
Degree after graduation (Bachelor/Master/PhD)

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MEMBERSHIP SERVICES
EAGE Membership includes:
Discount on all EAGE conferences and workshops worldwide
Every month a new issue of First Break (online & print)
Access to EarthDoc, EAGEs online geoscience database
Member discount at the online EAGE Bookshop
Free access to online learning through Learning Geoscience
Access to Members Only webpage (including member search)
One free online subscription to one of the following journals (please select one):
(tick one box only):
Geophysical Prospecting (6x per year) online
Petroleum Geoscience (4x per year) online
Near Surface Geophysics (6x per year) online
Basin Research (6x per year) online

Additional journals:
Geophysical Prospecting online
Geophysical Prospecting print1
Near Surface Geophysics online
Near Surface Geophysics print1
Petroleum Geoscience online
Petroleum Geoscience print1
Basin Research online
Basin Research print1
1

10
35
10
35
10
35
10
35

Only in combination with the online version of the journal

ADDITIONAL INFORMATION
Divisions
Oil & Gas Geoscience Division
Near Surface Geoscience Division
Both

Future job focus (max. 2 answers)

Academic Consulting
Economics/Planning
Engineering Geology
Environment
Exploration
Geophysical Data Acquisition
Geophysical Data Processing
HR Recruitment
Interpretation Studies
Management
Marketing/Sales
Production
Research/Development
Training

Interests (max. 2 answers)

CO2 Storage
Environment
Geochemistry
Geology
Geophysics
Geothermal
Mining
Petroleum Engineering
Petrophysics
Reservoir Engineering

Other society affiliations

AAPG
EEGS
EGU
IGA
PESGB
SEG
SPE
SPWLA
Other (Please specify)

METHODS OF PAYMENT
Please debit my credit card:

American Express

Visa

MasterCard/Access

Credit card number (plus security code): (American Express 4 digits and Visa/MasterCard 3 digits)

Expiry date:

security code

In the amount of Euros ()

Name of credit card holder
Signature of credit card holder
Paid by bank transfer in the amount of Euros ( )
Made out to: EAGE, Bank: ABN-AMRO Bank, The Netherlands, Account number: 51.15.27.306,
IBAN number: NL56ABNA0511527306, BIC/Swift code: ABNANL2A
Signature

Date

(dd/mm/yyyy)

I read the conditions for a student membership (first

paragraph of this application form) and I confirm
that I meet all requirements.

Please return the completed form together with a

copy of your student card to membership@eage.org.
EAGE Head Office
Membership Department
PO Box 59
3990 DB Houten
The Netherlands
Fax: +31 30 6343534

Date:

Signature applicant: