Tobacco Root Geological Society
Membership Application

Name:________________________________________________________
Address 1:_____________________________________________________
Address 2: _____________________________________________________
College or University attending:____________________________________
Agency or Affiliation:_____________________________________________
City:_____________________________________
State:______
Zip:________
Phone:__________________
Fax:____________________
E-mail:__________________________________

Student - $5

Professional - $25

Make your check out to:

The Tobacco Root Geological Society

and mail it to:

P.O. Box 2734
Missoula, MT 59806