Individual membership application form: Membership type: *Select oneIndividual - studentIndividual - associateIndividual - standardPrefixMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Last Name *Street Address *Apartment, suite, etcCity *State/ProvinceZIP / Postal CodeCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweEmail Address *Phone *Do you currently operate GPR equipment in the UK? *YesNoOfCom Licence No.: *If you operate GPR systems in the UK you are required to posses an GPR operator's licence.OfCom Licence Expiry Date: *Name of academic institution: *Description of work: *Provide a résumé of your activities and work with GPR. This information will help with your application. We recommend around 100 words.Details of tutor or supervisorThis person will contacted to confirm your course details.PrefixMr.Mrs.Ms.Mx.MissDr.Prof.First NameLast Name *Email Address: *PhoneReferees:Please provide the name and email address'/phone numbers of two referees. The referee should be a client or someone recognised within the GPR industry, ideally already a member of EuroGPR. Please agree this in advance with your referee. For academic individuals, references to peer reviewed publications may be entered instead.Referee A:Referee A type: *PersonPeer reviewed publicationName *Email Address *PhoneDetails of peer reviewed publication: *Referee B:Referee B type: *PersonPeer reviewed publicationName *Email Address *PhoneDetails of peer reviewed publication: *How would you like to pay for your membership? *AnnuallyMonthlyNo payment is due until your membership application has been approved as "Provisional".Please confirm the following: *Yes, I have read and understand the Code of Ethics and Memorandum of assocation.The association occasionally provides discounted membership at events by way of promotional codes.I have a promotional code.Promotional code:Submit ApplicationPlease do not fill in this field.
