SEG Application for
`Active Membership
`Connecting, inspiring, and propelling
`the people and science oÍ geophysies.
`
`lì,,* membership is available to anyone *ti'l
`I has B or more years experience (educational and/ |
`lg orofessional) in geophysics or a related fieldJ
`
`What is the most valuable benefit of becoming a member of SEG? Please select all that apply:
`tr Access to the most up-to-date information in the field.
`tr 0pportunities to network with other professionals/students in the field,
`tr Professional development and education.
`tr Volunteer opportunities.
`tr Access to career information and job opportunities.
`tr I want to give back to my indushy profession/industry.
`Please print or type your information as you would like ¡t to appear on your membership card.
`A Contact lnformation This is lrorrr: I Honte r 0f f rce
`tr Mr. tr Ms. tr Dr.
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`SEG lD Number (if previously a member):
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`lãte ofR'íñFIDD/MNITYYYY)-
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`E-mail A00ress (t{Euutt{tu)
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`Hn0ne Num0er
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`Last Name/Surname
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`rrrsr rrame/utven, Mt00te
`tr Male tr Female
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`A00ress Ltne I
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`A00ress Lrne 2
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`r"try
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`Postal/z¡p c0de
`Country
`tr Check here if you do not wish to receive e-mail solicitation other than those announcing SEG events provided as part of your membership benefits.
`
`State/Province
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`B Education
`Highest Applicable Degree Earned: tr BS tr MS tr PhD
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`Field of Study*
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`School Name:
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`Start Date:
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`C Professional History.
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`Graduation Date:
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`End Date:
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`End Date:
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`Start Date:
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`Job Title
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`Employer
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`Reponsibilities _
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`Start Date:
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`Job Title
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`Employer
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`I nnatinn
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`Start Date:
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`Job Title
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`Employer
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`Location
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`Reponsibilities _
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`Start Date:
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`Job
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`Employer
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`End Date:
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`End Date:
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`aël
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`Eligibility Requirements
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`*Educational
`
`and full-time professional
`work experience must be in geophys-
`ics or a related field, such as but
`not limited t0 physics, mathematics,
`engineering, or geology.
`
`Applicant's educational and/or full time
`professional work experience must
`total at least I years. Educational credit
`for the highest degree earned is:
`Bachelo/s degree = 4 years
`Maste/sdegree=Syears
`Doctoral degree = 7 years
`
`Calculate Experience
`
`Years of
`College Credit:
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`Years of
`Professional
`Experience:
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`Total Years
`of Experience
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`- '- ,,! -.: _
`-,iílS-Bìrv-
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`Reponsibilities
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`Reponsibilities
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`EXIIIBIT
`DATE
`REPORTER
`Pllntt
`Please return form with payment to: DEPT. #960478 . OKLAHOMA CITY, OK 73196-047g, USA
`PHONE +1-918-497-5581 ' FAX +1-918-497-5565 . member@seg.org o www.seg.org
`
`LLC
`
`PGS Exhibit 1077, pg. 1 PGS v. WesternGeco (IPR2014-00689)
`
`

`

`D Society/Section Affiliation (if applicable)
`lf you are currently a dues-paying member of one or more SEG Sections/Associated Societies, please list the one SEG Section or Associated Society with which you want
`to be identified:
`
`l
`
`I I i
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`I i
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`E Membership Dues
`SEG's dues structure is based on the membe/s World Bank county Classification. Select your membership rate based upon the region of the world in which you work or
`for World Bank information.
`reside, Visit http//seg.org/membership/overvieúworld-bank-country-classifications
`tr Group lV Countries US $95.00
`tr Group lll Countries US $50.00
`tr Group I and ll Countries US $13.00
`
`F My Benefits
`
`r Technical Program Expanded Abstracts, online
`t The Leading Edge, in print (for members in World Bank groups lV and lll)
`t The Leading Edge, online
`
`The following publications are included with your membership:
`I GEoPHYsrcs, online 1936-99
`r Global Meeting Abstracts, online
`r Journal of Env. & Eng. Geophysics, online
`r Symposium of the Application of Geophysics, online
`Pleaso seloct 1 addilional publicatlon(s) from the following, al no cosl l0 you: (you musl choose 1 ltee)
`tr G¡opHvsrcs online E lnterpretationonline
`Add 0n Subscriptions: Ghoose I (one) al lull prlce ot 2 (lwo) ot more at 10% ofl.
`tr GrorHvsrcs in print
`tr G¡opHvsrcs online
`E I nte rp retatio n in prinl
`E I nte r p retatio n online
`tr Exploration Geophysics (ASEG) online
`
`USD$65 (10% = $58.50)
`USD$40 (lV & lll) or $20 (l & ll) (10% discount = $36 or $18)
`USD$50 (10% ¡¡es6u¡1 = $45)
`USD$40 (lV & lll) or $20 (l & ll) (10% discount = $36 or $18)
`USD$25 (lV & lll) or $15 (l & ll) (10% discount = $22.50 or $13.50)
`
`G lnvoice and Membership Acceptance
`
`A. Membership Dues
`
`B. Additional Subscriptions (ir appticabh)
`
`C. Additional Subscriptions (ir applicable)
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`D. Additional Subscriptions ([ applicable)
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`Total Due = USD
`
`New applicants will receive benefits once payment has been processed. Dues for the next yea/s
`renewal will be prorated to compensate for an entire yea/s benefits. All applications and/or payments
`received on or aftell October will begin on 1 January of the next calendar year.
`
`Thankyou for applying fot membetship wilh SEG. llle appteciale ygur inl6resl ln becoming a
`msmber of the premier global geophyslcs sociely.
`
`lncomplete applications will be returned and must be completed and returned to SEG within 30 days.
`
`H Code of Ethics
`I hereby attest that, pursuant t0 the requirements for acceptance in the Society of Exploration Geophysicists, I am actively interested in geophysics, and accept the Code
`of Ethics as stated on http//seg.org/segigovernance-docs/code'of'ethics.
`
`Signature
`
`Date
`
`f Payment
`tr Check (make payable to SEG in U. S. dollars)
`tr Wire Transfer (lf selecting wire transfer as a method of payment, an SEG representative will contact you with the wire transfer details.)
`
`-)i.i#iqsi.'--
`--\-\\ÞdilÞ-?-
`
`Please return form with payment to: DEPT. #960478 . OKLAHOMA CITY, OK 73196-0478, USA
`pHoNE +1-g18-497-5581 . FAX +1-918-497-5565 . member@seg.org . www.seg.org
`
`PGS Exhibit 1077, pg. 2 PGS v. WesternGeco (IPR2014-00689)
`
`