12 Baylis Mews
Amyand Park Road
Twickenham TW1 3HQ
United Kingdom
Tel: +44 (0)20 8891 6600
Fax: +44 (0)20 8891 6599
Email: info@minersoc.org
www.minersoc.org
MINERALOGICAL SOCIETY
Membership Application Form 2014
Applicant’s details (please type or use BLOCK CAPITALS)
Surname
First Name(s)
Title (Ms/Mrs/Mr/Dr/Prof/other, please specify)
Date of Birth (dd/mm/yyyy)
  
Mailing Address
Postal Code
Tel No.
Fax No.
Country
Email Address
Membership Rates (incl. Elements)
Members and Fellows
£40.00 
Student Members: first year of membership (thereafter £10.00)
FREE 
Journal Rates
Mineralogical Magazine (print copy)
£37.00 
Clay Minerals (print copy)
£37.00 
Mineralogical Magazine AND Clay Minerals (both print copy)
£60.00 
Online-only Access (2 journals)
Mineralogical Magazine, Clay Minerals
£20.00 
Membership of Groups (You may wish to indicate your
interests; no extra fee; no limit to the number of groups you join)
Membership includes Elements,
the international bi-monthly magazine
of mineralogy, petrology and
geochemistry.
For other journals, as print or onlineonly, there are additional rates (listed).
All rates are quoted as GBP.
Please indicate  the membership you
are applying for, including any journals.
Total payable
£ _________
Payment Details
Applied Mineralogy Group

Clay Minerals Group

Payment can only be made by GBP (£) cheque - payable
to the Mineralogical Society, or by VISA, MasterCard,
American Express or Switch/Maestro (please indicate).
Geochemistry Group

Sterling Cheque
Metamorphic Studies Group

MasterCard
Mineral Physics Group

Volcanic & Magmatic Studies Group

Environmental Mineralogy Group

Verification of Student Status (where applicable)
Student applicants do not need a Declaration of Proposers but must
supply details of a faculty member who can verify student status.
Switch/Maestro
 (enclosed)
VISA


American Express 
 (Issue No……………………..)
Please provide debit card number
   
Security Code

(last 3 digits on back of card)
Valid from (mm/yy)
 
Institution & Department
Cardholder’s name
Faculty Member (name)
House No
Expiry Date (mm/yy)
 
Address
Postal code
Email Address
Signature
Declaration of Proposers (Members & Fellows application)
As Members of the Society we propose this person as suitable to be a Member of the Society & verify the details supplied are correct.
Proposed by
Seconded by
Signature
Signature
(The Society President and General Secretary will be happy to propose you if you do not know other members.)
Additional Information (This is necessary for those wishing to apply for Chartered Scientist; eligibility after 5 years membership).
Institution / Company & Department
Address (including postal code)
Degrees & Honours (please provide institution & date)
Applicant’s Signature
Registered Charity 233706
Date
VAT Reg No GB 238767617