Membership Application

Print this form, fill it out and mail it to the address below

Name:                                                                                                          . 

Mailing Address:                                                                                           .

City:                                                                       State:       ZIP:                 .

Affiliation (institution):                                                                                    .

Phone:                            Email:                                                                     .

Directory Authorization:  CGS is planning the distribution of a membership directory.  Please indicate if you would like your name and address included (please check)

   Name and email only

   Name, email and address

   Please DO NOT include my name in the directory.

Indicate your Membership Category

Life -        $250 ________

Regular - $25   ________

Retired -  $ 20  ________

Student - $ 15  ________

Student* -$ 10  ________

Enclose a check for the amount corresponding to your membership category, payable to “The California Geographical Society”

Mail it to:

CGS

1149 East Steffen Street

Glendora, CA

91741-3736