G R C M E M B E R S H I P A P P…

                                       G R C M E M B E R S H I P A P P L I C AT I O N


GEOTHERMAL RESOURCES COUNCIL                                         MEMBERSHIP RATES

P.O. Box 1350                                                        (Per Calendar Year)                                                 U.S.   International
Davis, California 95617-1350                                         Individual . . . . . . . . . . . . . . .$100                                 $150   
Phone: (530) 758-2360                                                Student . . . . . . . . . . . . . . . . . 40                                   90   
Fax: (530) 758-2839                                                  Benefactor . . . . . . . . . . . . . . .180                                   230   
E-mail: grc@geothermal.org                                           Retired . . . . . . . . . . . . . . . . . . 50                                100   
                                                                        *Must be over 65 years of age, retired.

                                                                     Bulletin Subscription only . . . . .$90                                      $140 
APPLICATION
                                                                     Corporate:
Please complete the following form and return it with
                                                                     Company . .        .   .   .   .   .   .   .   .   .   .   .   .$ 500       $ 550   
payment by check or credit card (see below).
                                                                     Supporting .       .   .   .   .   .   .   .   .   .   .   .    1,000       1,050   
                                                                     Sustaining . .     .   .   .   .   .   .   .   .   .   .   .   .1,750       1,800   
NAME                                                                 Patron . . . . .   .   .   .   .   .   .   .   .   .   .   .   .2,500       2,550   

TITLE                                                                Group Member Rates Available! Call for Details.

ORGANIZATION


                                                                     Corporate Representatives
                                                                     Your Corporate Membership provides various levels of repre-
ADDRESS
                                                                     sentation for your organization. Each representative can vote
CITY                                                                 in GRC Board of Directors elections, and receives the GRC
                                                                     Bulletin, Membership Roster and Registry of Geothermal
PROVINCE/PREFECTURE/STATE                                            Services & Equipment, Annual Meeting information and work-
                                                                     shop flyers. Take advantage of the representation your
COUNTRY                                          ZIP
                                                                     membership allows at the following levels: Company (two
PHONE                                                                memberships); Supporting (three memberships); Sustaining
                                                                     (four memberships); and Patron (five memberships).
FAX
                                                                     NAME (CONTACT)
E-MAIL
                                                                     NAME (OTHER)
MAJOR AREA OF INTEREST
                                                                     NAME (OTHER)
REFERRED TO GRC MEMBERSHIP BY
                                                                     NAME (OTHER)


                                                                     NAME (OTHER)




                     Please make payable to the Geothermal Resources Council

                      Mastercard             VISA       American Express
                      Personal Card          Corporate Card

                     CARD NUMBER                                                                EXP. DATE


                     SIGNATURE                                                                  DATE SIGNED


                     BILLING ADDRESS


                      Personal bank checks must be drawn on U.S. Bank account in U.S. Funds

                     Amount Enclosed: $_____________