GEOTHERMAL ENERGY ASSOCIATION
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Membership Payment form
Methods of Payment Payments to be made in US dollars.
Today is: 2/4/2012
CHECK
- if paying by check, please made payable to: Geothermal Energy Association
Check number:
Date:
Ammount:
WIRE TRANSFER
- If you need to make a payment via wire transfer, please contact GEA for instructions. A copy of the wire transfer must be submitted with the exhibit application.
CREDIT CARD
Type
VISA
MASTER CARD
AMERICAN EXPRESS
Card Number
Name as it appears on the card
Expiration Date (mm/dd/yy)
I authorize the Geothermal Energy Association to charge to the account identified abovethe amount of $:
I prefer a confirmation by:
e-mail at
fax at
Please complete this form, print it out and Fax it at (202)454-5265
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