* Designates a required field.

Students who are registered as full-time undergraduates or graduates in a geoscience program in a university or other recognized academic institution are eligible to apply for Student Member status in PGO. Membership allows access to the services of the Association and receipt of e-mail updates.

Legal Name (for registration, certificate and seal and/or stamp use)

Salutation*:	-- Dr. Mr. Mrs. Ms. Miss M. Mme Mlle
First Name*:
Middle Name(s):
Last Name*:
Telephone:
E-mail*:
Alternate E-mail:

Mailing Address

Address*:
Address Line 2:
City*:
Province or State*:	Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PU RI SC SD TN TX UT VA VI VT WA WI WV WY
Other Province (International):
Country*:	-- Canada United States Afghanistan Albania Algeria Angola Anguilla Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Cote dIvoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Fiji Finland France Gabon Gambia Georgia Germany Ghana Gibraltar Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Lithuania Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Helena Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam West Bank and Gaza Yemen Zambia Zimbabwe
Postal/Zip code*:

Education

Do you hold a B.Sc. Degree in Geoscience*?	Yes No
If yes, please specify date granted*
Specify current degree program in which you are registered (e.g. B.Sc. (4-Year), M.Sc., M.BA., Ph.D.)*:
Field of Study (e.g. Geology, Earth Sciences, Geophysics, Geoscience, other)*:
Please specify expected date of graduation*
Name of Institution*:	-- Algoma University Brock University Carleton University University of Guelph Lakehead University Laurentian University McMaster University Nipissing University University of Ottawa Queens University Ryerson University University of Toronto Trent University University of Ontario Institute of Technology University of Waterloo Western University Wilfred Laurier University University of Windsor York University
Other Institution:

Consent

Student ID #: