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NEW Membership Application 2011 To join The Clay Minerals Society (CMS), send a copy of this application, along with the required payments for dues and subscriptions, to The Clay Minerals Society, 3635 Concorde Pkwy Ste 500, Chantilly, VA 20151-1110, USA ph: (703) 652-9960, fax: (703) 652-9951, e-mail: firstname.lastname@example.org. Membership applications received after October 1, 2010 will be made effective with a paid thru date of December 31, 2011 unless otherwise requested. The Clay and Clay Minerals (C&CM) journal is published in February, April, June, August, October, and December. Back issues are mailed to subscribers to the paper version. Address Information: [ ] Dr. Name: [ ] Prof Given (First) Middle Family (Last) [ ] Mr. Address: [ ] Ms. [ ] Mrs. [ ] Other E-mail: Phone: Fax: Make Selection(s): For calendar year Jan-Dec 2011 (NOTE: you must be a CMS member to purchase the journal) [ ] Membership – Elements (no journal) $ 60.00 [ ] Student* - Elements & online access to C&CM $ 25.00 [ ] C&CM paper + online access (US address) $70.00 [ ] C&CM paper + online access (non-US address) $85.00 [ ] C&CM online access $35.00 [ ] Student* C&CM paper discounted rate $40.00 [ ] Clay Minerals (UK) discounted student/member $65.00 TOTAL $ *Student Certification: (Applicants for student membership must supply the following information.) Institution Location Degree sought Expected completion date A faculty member who can verify your student status: Name E-mail Payment: Please use Visa, MasterCard, Discover, American Express or a check in U.S. dollars, drawn on a U.S. bank, payable to The Clay Minerals Society. Do not send credit card information by e-mail. US$ ________________ enclosed, or charge my: [ ] Mastercard [ ] Visa [ ] Discover [ ] Amex credit card Card # Exp. Date: Cardholder: Signature: Card Verification Value (last 3 or 4 digits above signature panel on back For more information, contact The Clay Minerals Society, 3635 Concorde Pkwy Ste 500, Chantilly, VA 20151-1110, USA ph: (703) 652-9960, fax: (703) 652-9951e-mail: email@example.com or visit the website at www.clays.org.
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