Questionnaire for Contributors

Please send this information by 1 January 2013.

If you prefer you may use this MS Word Form to complete, save and attach to an email to AAPG.

Name:

Affiliation:

Address:

Telephone:

FAX:

e-mail:

attend the Conference.

contribute a presentation.

Title or Topic:

willing to act as session chairman for one of the symposium themes.

Theme:

prepare a written contribution toward a conference volume (most likely an AAPG Memoir).

Names of other potential contributors who should be invited to participate (please email additional names to AAPG Education Department or fax to 918-560-2678, Attn: Hedberg Attendees):

Name:	Affiliation:	Address:
Telephone:	Fax:	email:
Name:	Affiliation:	Address:
Telephone:	Fax:	email:
Name:	Affiliation:	Address:
Telephone:	Fax:	email:
Name:	Affiliation:	Address:
Telephone:	Fax:	email:

Please send this information by 1 January 2013.
This data is being transmitted to Debbi Boonstra in the AAPG Education Department.

Please enter the above text exactly in the field provided below to validate this submission.

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Questionnaire for Contributors