Membership Form | PBS-SEPM

membership SignUp or Renewal

pbs-sepm membership application/renewal

Permian Basin Section - SEPM

Membership Year June 1 - May 31

2900 W Front St

Midland, TX 79701

Phone: 432-279-1360

Email: info@pbs-sepm.org

Complete the online form and pay via PayPal.

Otherwise, renew via USPS Mail with the completed form, printed, and with a CHECK made out to: PBS-SEPM.

Personal Information

Full Name:

Spouse's Name(If applicable):

Home Address / Phone #:

Primary Email Address:

Professional Information

Company Name / Title:

Company Address / Phone#:

Preferred Mailing Address

Home Address

Work Address

Universities, Degrees, Majors, Year(s) Graduated:

Would You Serve on one the Committees?

Luncheon Speaker Committee

Robert Read Distinguished Lecturer Committee

Field Trip Committee

Core Workshop Committee

Scholarship Committee

Honorary Lifetime Membership Committee

Young Professional Field Trip Committee

Are you a member of any of the following?

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Membership Dues:

$25.00

Wendell J. Stewart Scholarship Fund:

Robert Read Jr. Memorial Fund:

(Helps offset the Distinguished Lecturer Expenses)

***DISCLAIMER***

Before paying, please fill out the form and select SUBMIT.

If not donating please enter "0" values in both boxes. Then click the PayPal Buy Now button to be redirected to PBS-SEPM PayPal Site to submit the membership payment, or send a check if you prefer to the mailing address.

If donating, please enter the amount in both boxes, then click SUBMIT. Once content has been submitted, select the PayPal Donate button to be redirected to the PBS-SEPM PayPal Site. Re-enter the amount and submit.

PBS-SEPM is an educational non-profit, 501(c)(3) organization. Thank you for your support!