ICE Cancun 2016

Contact Information

Priority Code (If applicable)
* FirstName/Forename
Nick Name/First Name (will appear on badge)
* Last/Surname (will appear on badge)
Title
* Company/University (will appear on badge)
Day Telephone
Mobile Telephone
* E-mail
* Address Line 1
Address Line 2
* City (will appear on badge)
* Zip/ Postal Code
State (will appear on badge)
* Country of Residence (will appear on badge)
Country of Citizenship
Primary Emergency Contact Name?
Relationship
Home Telephone
Mobile Telephone
List any Medical Conditions/Allergies you may have
Member Number (If Applicable)

Demographic Information

Are you a member of any of the following? Check all that apply
American Association of Petroleum Geologists (AAPG) American Association of Stratigraphic Palynologists (AASP)
Mexican Association of Exploration Geophysicists (AMGE) Mexican Association of Petroleum Geologists (AMGP)
Association of Women Geoscientists (AWG) Circum-Pacific Council for Energy & Minerals Resources, Inc. (CPC)
Geological Society of America (GSA) International Association for Mathematical Geology (IAMG)
National Association of Black Geologists & Geophysicists (NABGG) Petroleum Exploration Society of Australia (PESA)
Society of Exploration Geophysicists (SEG) Society for Sedimentary Geology (SEPM)
Society of Independent Professional Earth Scientists (SIPES) Society of Petroleum Engineers (SPE)
Society of Petropysicists & Well Log Analysts (SPWLA) The Society for Organic Petrology (TSOP)
None of the above
I am an officer/president of: Check all that apply
Region President Section President
Region Officer Section Officer
Affiliated/Associated Society President
I am a: Check all that apply
Conference Committee Chair Field Trip Leader
Poster Presenter Session Chair
Short Course Instructor Speaker
Technical Program Committee Member Exhibitor
Which best describes your occupation?
Academic Engineer
Geologist Geophysicist
Landman Other
Please Specify:
Which best describes your position?
CEO/President Independent Consultant
Manager Professor
Retired Staff Employee
Student Vice President
Other
Please Specify:
Age:
24 and under 25-29
30-39 40-49
50-59 60-69
70+
Gender:
Female
Male
Other
I wish to receive updates for ICE Events via mail/email
I need a letter for visa purposes
Special Needs?
Wheelchair Rental
Wheelchair Accessible
Vegetarian
Other Dietary Needs
Please Specify:
I belong to the following AAPG Division(s):
Division of Environmental Geosciences (DEG)
Division of Professional Affairs (DPA)
Energy Mineral Division (EMD)
Petroleum Structures and Geomechanics Division (PSGD)

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