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Application for

FELLOWSHIP & CANDIDATE FELLOWSHIP

FOR OFFICE USE ONLY


DB Contact No
Fellowship No

Date Form Received

Election Date

Enclosed
1 Year

Full Course

22-27

28-33

34-59

CC
34-59
OS

60-69

70+

Date Payments sent to


Accounts
CHQ
CASH
DD

Joint Fellow Number:

ALL APPLICANTS TO COMPLETE


Title

Last name

Date of birth

_____/_____/19

First names (in full)


Sex

Nationality

Home address

School/University/Work address

Postcode/Zip

Postcode/Zip

Country

Country

Telephone no

Telephone no

Email
FELLOWSHIP OPTIONS

Alternative email (if applicable)

Please tick the grade of Fellowship that you wish to apply for:
Candidate Fellowship (Please complete Section A and Section C)
Candidate Fellow.

Please tick if you have previously been a Fellow or

Fellowship (Please complete section A [if appropriate], Section B and Section C)


MAILING OPTIONS
Please tick which address journals and correspondence should be sent to.
Home

School/University/Work

All Fellows (names) will be added to the online Fellows directory. Please tick this box if you also wish to add your address and email.
Emails
The Society would like to keep you informed of its activities by email, including those of any Regional and Specialist Groups of which
you are a member. Please tick this box if you do not wish to receive this information.
Paper Renewal Invoice
Renewal letters for your Fellowship will be sent by email. Please tick this box if you require a paper renewal invoice by post
Fellowship Directory
All Fellows names will be added to the online Fellowship directory. Please tick this box if you also wish to add your address and email.
(You can select other visibility options on the website log in and go to My GSL/Edit Fellowship Details.)
The Geological Society will not pass your details to any other organisation.
SECTION A (CANDIDATE FELLOWSHIP & FELLOWSHIP)
If you are applying for Candidate Fellowship, or if you are a full-time postgraduate student applying for Fellowship, please supply
details of your current studies.
Name of School or University ____________________________________________________________________________
Course(s) level & title
Course Ends

_____________________________________________________________________________
____/____/20____

SECTION B (FELLOWSHIP ONLY)

A)

SPECIAL RATE FOR JOINT FELLOWS

For two Fellows at the same home address. Annual fee is the higher of the two Fellowship fees plus a supplement Joint Fellows receive
one free journal, plus Geoscientist .
I wish to apply for Joint Fellowship with ______________________________________________________ (full name).
I confirm that we have the same home address.

ACADEMIC QUALIFICATIONS
Please supplyAWARD
details&ofSUBJECT
higher education and vocational
CLASS qualifications.
YEAR OF AWARD

NAME OF COLLEGE/UNIVERSITY

MEMBERSHIP OF OTHER BODIES (PROFESSIONAL AND/OR SCIENTIFIC)


NAME OF ORGANISATION

STATUS

YEAR ELECTED

EXPERIENCE / OCCUPATIONS
Applicants who do not have an appropriate degree or equivalent qualification and are applying through the experience route should
submit a CV detailing their relevant experience. This should give details of relevant employment in chronological order, including for
each position the employer's name and location, dates and nature of duties.

SECTION C (CANDIDATE FELLOWSHIP AND FELLOWSHIP)

All elected Fellows and Candidate Fellows will be allocated to a Regional Group on the basis of their mailing address.
The Society has 23 Specialist Groups and Joint Associations, catering for most aspects of modern Earth science. Membership of the
Joint Associations and affiliated Specialist Groups is not restricted to Society members and may involve a separate fee. These groups
are not listed below, but information about them can be found on our website at www.geolsoc.org.uk/groups.
If you would like to join a Specialist Group, please tick the boxes of the Groups you would like to join:
Borehole Research Group
Environmental Group
Marine Studies Group

Coal Group
Earth System Science Group
Petroleum Group

Engineering Group
Hydro geological Group
Forensic Geology Group

PROPOSERS
Applicants are normally required to find two proposers who are Fellows of the Society. For applicants resident overseas and for
others who have difficulty in identifying Fellows to act as proposers, Council will act as their proposers
PROPOSER 1
PROPOSER 2
Name
Name
Address
Address
Fellowship Number:
Please tick this box if you do not have a proposer

Fellowship Number:

I declare that I am willing to support the aims of the Geological Society of London and wish to apply for admission to
Candidate Fellowship/Fellowship of the Society.
I declare that the statements made throughout this application are correct.
I agree that if elected to Candidate Fellowship/Fellowship, I will observe its Bye-laws and Regulations, including the Code of
Conduct.
I agree that if elected to Candidate Fellowship/Fellowship, I shall endeavour to promote the interests and welfare of the
Society.
I further agree that I shall pay such dues as required of me on or before the specified dates and in the manner prescribed by
Council.
I agree to the Societys terms and conditions for use of electronic services, which can be viewed online at
www.geolsoc.org.uk/eterms

Signature __________________________________________________________ Date_______________________________


The completed form and payment should be returned to: Administrative Fellowship Secretary, The Geological Society, Burlington
House, Piccadilly, London, W1J 0BG, UK.
MARKETING
To help us improve the quality of service we provide please a take few minutes to answer the questions below;
How did you hear about the society?
Conference
Event at Burlington House
External GSL Event
Friend/Colleague
GSL Fellows
University
Journal Advertisements
Other please state
What are your main reasons for applying for Fellowship/Candidate Fellowship?

PAYMENTS & JOURNAL REQUEST 2015


NAME:
1. ADMISSION FEES
(one-off payment)
FELLOWS ONLY

RATE

TICK

AMOUNT

Note: 20 not payable if you are:


a previous Fellow of the Society

20.00

or a full-time postgraduate student


2. ANNUAL FEES
CANDIDATE FELLOW

FELLOW
Please note that your age
bracket is calculated on
how old you are on 31
December 2013

Full or part-time undergraduate degree student of any age

15.00

One-off fee for duration of full-time undergraduate course

40.00

Aged 27 and under

70.00

Aged 28 33

130.00

Aged 34 59

198.00

Aged 34 59 and resident outside Europe

152.00

Aged 60 69

99.00

Aged 70 or over

68.00

Full-time MSc students (reduced fee for all ages)

28.00

Full-time PhD students (reduced fee for all age)

41.00

Joint Fellowship Supplement

58.00
3. FREE JOURNAL
Choose one title only. Please note your free journal will be provided in electronic format only, unless an annual 12.50 supplement
is paid to receive all issues of the free journal in hard copy
Journal of the Geological Society
(6 issues per/yr)
FREE
OR Quarterly Journal of Engineering Geology & Hydrogeology
OR Petroleum Geoscience

(4 issues per/yr)
(4 issues per/yr)

OR Geochemistry: Exploration, Environment, Analysis

(4 issues per/yr)

FREE
FREE
FREE

SUPPLEMENT FOR HARD COPY OF FREE JOURNAL


12.50
4. ADDITIONAL JOURNALS / LYELL FULL BOOK COLLECTION
Please note that all additional Journals will be provided in electronic format only, unless an annual 12.50 supplement is paid to
receive all issues of the chosen journal in hard copy
Journal of the Geological Society
41.00
Quarterly Journal of Engineering Geology & Hydrogeology

41.00

Petroleum Geoscience

41.00

Geochemistry: Exploration, Environment, Analysis

41.00

Geology Today

50.00

Geology

60.00

Full Book Collection

80.00

Geofacets GSL Millennium edition

37.50

GRAND TOTAL:
To pay by credit card, please supply card details on the enclosed form. To pay by cheque please make your cheque
payable to The Geological Society.

Credit Card Charge Authorisation


I wish to pay by Visa/ MasterCard/American Express
(please delete as necessary)
Please debit my account number (the long number across the face of the card) :

Start
Date

Expiry Issue Security Code


Date Numb
er
Name Signature
on
card

Addre Date
ss at
which
your
card is
regist
ered

FIRST YEAR SUBSCRIPTION


FOR
OFFIC
E USE
ONLY
Admission Fee 20
Contac
t No
Subscription Fee
Apply
for
Fellow
/Candi
date
Fellow
Extra Journal JGS QJEG PG EG GT G LFBC
Electio
n Date
Hard Copy supplement: Free Journal /Extra Journal
Please complete and return your form to the Fellowship Office, Geological Society, Burlington House, Piccadill y,

W1J 0BG

London,