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Students > Corporate Sponsorship Program > Request Form

Corporate Sponsorship Program

Yes, I wish to have Chevron Corporation pay my AAPG Student membership dues under the Corporate Sponsorship Program. I understand and agree that information about me contained in AAPG’s records will be sent by AAPG to Chevron Corporation for use as determined solely by Chevron, and I hereby authorize AAPG to provide such information to Chevron.
Name: (required)
AAPG Member Number: (required)
eSignature (required)
By attaching the signature to this application form, I agree and understand that my typed electronic signature shall have the same legal effect as an original signature and is being accepted as my original signature pursuant to the Colorado Uniform Electronic Transactions Act, Colorado Revised Statutes, 24-71.3-101 et seq.
Date:

I will be continuing school and would like my dues sponsored for FY2012-13 dues
(fiscal year ending June 30, 2013).

My expected graduation date is
As of July 1, 2012 I will be pursuing a

Studying:

University / Institution:

No, I have graduated and am now employed at:

Please update my classification to Associate AAPG member and bill me accordingly for FY 2012-13

Email: (required)

Please enter the above text exactly in the field provided below to validate this submission.

The above information is being sent to AAPG’s Student Affairs Coordinator at AAPG headquarters.