Name of Institution / Organisation

Address

Telephone number

Fax number

E-mail

Person to whom correspodence is to be addressed

Position in Institution/organisation

Membership applied for (please fill up one)

REGULAR MEMBER

US $150 (equivalent) (Institutions with annual turnover less than US $5 million).
US $400 (equivalent) (Institutions with annual turnover exceeding US $5 million).

AFFILIATE MEMBER

US $500 (equivalent)

Signed

Position

Date