Membership Form


VERY IMPORTANT INSTRUCTION: Please type the information into this form directly and then upload your scanned signature as appropriate. You may leave the signature space blank if you can’t scan your signature at this time.

Personal Data

Prefix (select appropriate title) :

First and Middle Names :

Family Name :

Gender :

Date of Birth :

Email :

Phone (home) (optional) :

Phone (work) :

Fax (optional) :

Personal URL (optional) :

Postal Address for Surface Mails (optional):

Professional Data

Affiliation/Institution/Company :

Department :

Address :

Town/City :

State/Province :

Country :

ACADEMIC RECORDS: Your academic background (degrees, where and when obtained, and a statement of your specialization).

One record per Line

Format -
Degree University - Year of Graduation - Course
(mention the major Subject) - Specialization

Scientific Interest(s)

Areas of Scientific Interest include :

  1. Solid Earth Science
  2. Atmospheric Science
  3. Ocean Science
  4. Astronomy and Planetary Science
  5. Solar and Terrestrial
  6. Hydrological Science

Please indicate section(s) of interest :

Referees: Give addresses, email and telephone of two referees who can be contacted


DECLARATION: I wish to become a member of African Geophysical Society and declare that the information in this application is correct to the best of my knowledge.


Upload Scanned Signature :

Passport Photograph :

NOTE: By submitting this form, you agree to tender an application for membership of AGS.

Today's Date :