Society of Economic Geologists, Inc.

7811 Shaffer Parkway  •  Littleton, CO 80127-3732 USA  •  Tel: +1.720.981.7882  •  Fax: +1.720.981.7874  •  E-mail: seg@segweb.org

Membership Application
Membership in the Society is open to all geoscience graduates holding a bachelor’s degree. Student members must be enrolled
full-time in earth science at a degree-granting college or university at the undergraduate or graduate level. The semi-quar-
terly journal, Economic Geology, and the quarterly SEG Newsletter are included in the ­membership. Applicants should
submit this form with the appropriate sponsor signature to the above address.

Section I (to be completed by applicant)

Personal Information: (Type or Print)
Torres Sanchez
Ms / Mr / Dr ____________________________________________________ Dayron
____________________________________ 30-08-1994
___________ Date of Birth___________________
Last Name First Name Middle Initial Mo. Day Yr.
Universidad Nacional Del Altiplano - Puno
Company / Institution_______________________________________________________________________________________________________________________________

Provide Mailing Address   ✔

M Home or  Av. Floral 467
M Business____________________________________________________________________________________________________
Puno
City_________________________________________ Puno
State/Province________________________ Postal Code__21000 Perú
__________________ Country___________________________

Phone____________________________________________ Cell__968552407
___________________________________________ Fax_____________________________________________
dayrontorres666@hotmail.com
Email___________________________________________________________________ Alternate Email____________________________________________________________

Male  M
✔     Female  M

Education: (Type or Print)

UNIVERSITY AND LOCATION YEARS DEGREE YEAR
Universidad Nacional Del Altiplano 2015 To__________
Highest Degree: _______________________________________________From_________ 2019 ____________________________________________
VII Semester 3
__________

Other Degree: _______________________________________________From_________ To__________ ____________________________________________ __________

_______________________________________________From_________ To__________ ____________________________________________ __________

_______________________________________________From_________ To__________ ____________________________________________ __________

Professional Experience: (List in order with most recent at the top)

YEARS (M/YR) POSITION EMPLOYER

From__________PRESENT ______________________________________________________ ____________________________________________________________

From__________To_________ ______________________________________________________ ____________________________________________________________

From__________To_________ ______________________________________________________ ____________________________________________________________

From__________To_________ ______________________________________________________ ____________________________________________________________

Section II (to be completed by the sponsor who must be a fellow of the society)
I sponsor the above-named individual for M MEMBERSHIP M STUDENT MEMBERSHIP
To the best of my knowledge the information provided by the applicant is correct.

Sponsor’s Name (Type or Print)___________________________________________________ Email Address or Phone Number_________________________________________

Firmado digitalmente porCristian Tony
DN: cn=Cristian Tony gn=Cristian Tony c=Perú l=PE o=Student Chapter UNA PUNO e=cristian1pari2pc@gmali.com

Cristian Tony
M FELLOW, Society of Economic Geologists, Inc.
Motivo:Soy el autor de este documento

Signature________________________________________________________ Date___________________________
Ubicación:
Fecha:2018-04-27 02:02+19:00

M HEAD, Earth Science Dept. (For Student Sponsorships)

Section III
Payment: When the application is approved, I authorize the Society of Economic Geologists, Inc. to charge the appropriate membership dues to:
M
✔ VISA   M MASTERCARD   M AMEX   M DISCOVER       M CHECK (US Funds – Payable to S.E.G.) 20
US $___________________
4214100170384533
Card No._____________________________________________________________________ 373
Card Security Code____________________ Expiry Date__04/21 /
________________
(3–4 digit code on back/front of credit card)

Print Name as it appears on card____________________________________________________________________________________________________________________

Firmado digitalmente por Dayron
Dayron
Signature of Applicant_______________________________________________________________________________________
Fecha: 2018.05.01 00:40:36 -05'00' Date__01/05/2018
______________________________

All new membership applications processed in the period SEPTEMBER 1 to DECEMBER 31

will have an effective date of the following JANUARY 1.

MEMBERSHIP CATEGORIES AND BENEFITS ARE DETAILED ON THE NEXT PAGE — PLEASE INDICATE YOUR SELECTION
08/2017
 Society of Economic Geologists, Inc.
7811 Shaffer Parkway  •  Littleton, CO 80127-3732 USA  •  Tel: +1.720.981.7882  •  Fax: +1.720.981.7874  •  E-mail: seg@segweb.org

Explanation of Membership Benefits for 2018

BENEFITS FOR ALL MEMBERSHIP TYPES

All members are eligible for discounts of at least 20% on the purchase of SEG publications, including electronic documents (e-Docs),
and significantly reduced registration fees (especially for students) at conferences, courses, and field trips sponsored by SEG. Please
note that any changes you make to your membership category are effective immediately. Members can keep informed of SEG news
and events by following us on Facebook, Twitter, and LinkedIn.
Member-only content:
• The benchmark journal, Economic Geology, with full access to the complete archive of 9,000 articles (from 1905). Content is
optimized for mobile devices.
• The SEG Newsletter (from April 1990).
• The SEG Membership Directory (search by name or location).
• E-mail alerts for publication releases including Table of Contents for Economic Geology.
• Use your discounted pricing at the SEG Store containing a complete listing and description of SEG publications.
Note:  SEG dues are based on the calendar year (January to December).

GEOFACETS
m SEG continues to offer annual fee-based access to scientific maps published in Economic Geology from 2000 to present through
Geofacets. This intuitive interface enables an efficient assessment of a region’s geologic char­acteristics and mineral potential,
and will serve as a strong complement to our existing archive of more than 9,000 articles of Economic Geology. Geofacets-SEG
Millennium Edition will operate similar to the Geofacets Corporate Version but with a select database of maps geared to the
minerals industry. To learn more, visit www.segweb.org/geofacets. [US $49/year]

MEMBERSHIP CATEGORIES
Member/Fellow
M
Electronic Only: Online access to Economic Geology and the SEG Newsletter. [US $95/year]
M Electronic + Print Newsletter: Online access to Economic Geology and the SEG Newsletter, as well as print copies of the
newsletter by mail. [US $130/year]
M Electronic + Print Newsletter & Journal: Online access to Economic Geology and the SEG Newsletter, as well as print
copies of both publications by mail. [US $190/year]
Couples
M Couples 2nd memberships are available. First member pays Electronic + Print Newsletter & Journal dues as above;
second membership is Electronic Only. [US $35/year]
Second member must also submit an application, if not already a member.
Please provide spouse’s name:_________________________________________________________________________
Students
M
✔ Electronic Only: Online access to Economic Geology and the SEG Newsletter. [US $20/year]
M Electronic + Print Newsletter: Online access to Economic Geology and the SEG Newsletter, as well as print copies of the
newsletter by mail. [US $55/year]
M Electronic + Print Newsletter & Journal: Online access to Economic Geology and the SEG Newsletter, as well as print
copies of both publications by mail. [US $120/year]

NOTE: All student members must provide written documentation of full-time enrollment for the current academic year.
Documentation may include one of the following: dated ID card that states “Full Time”, dated fee statement, dated letter from
advisor or university registrar. Applications will not be processed without proper documentation.

FELLOWSHIP APPLICATION
Professionals with a minimum of eight years experience and three years in a position of responsibility are
encouraged to apply for Fellowship. Please request a Fellowship Application Form or download from
the SEG website at www.segweb.org/pdf/forms/Fellowship-Application-Form.pdf