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(please check)
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Mr. O Mrs. O Ms. O
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Title
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First Name
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_____________________________________ |
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Family Name
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_____________________________________ |
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Private Adress
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Postal Code, City
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_____________________________________ |
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Country
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Phone
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_____________________________________ |
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Fax
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_____________________________________ |
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Email
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_____________________________________ |
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Membership fees
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(please check appropriate circle) |
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---ordinary members---
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O US$90* if paid with credit card or cash
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---ordinary members---
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O US$40* if not subscribed to journal Ecological Engineering
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---low salary countries---
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O US$45* if paid with credit card or cash
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---low salary countries---
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O US$10* if not subscribed to journal Ecological Engineering |
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---students---
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O US$50* copy of valid student ID is required |
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---students---
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O US$10* if not subscribed to journal Ecological Engineering |
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* If paid by check: plus US$5 |
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Note
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The journal can only be subscribed for whole calendar years. Please indicate when you want your membership to begin:
O 2011
O 2012
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Method of payment
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O Cash
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O Direct bank transfer:
Banc Account: Valiant Bank, CH-6110 Wolhusen,
SWIFT/BIC-Nr.: VABE CH22;
IBAN-Nr.: CH26 0630 0016 1853 8551 0;
Account number: 16 1.853.855.10
Account-holder: IEES, c/o Bahnhofstrasse 2, CH-6110 Wolhusen |
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O I enclose a check (plus US$5 per year)
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O please charge membership fee to my credit card
o American Express
o Mastercard/Eurocard
o Visa |
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Card Nr.
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Cardholder's Name
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___________________________________________________ |
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Expiration Date
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___________________________________________________ |
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CVC2/CVV2 (last 3 digits in signature field)
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| Yes, I wish to become a member of IEES. I accept the articles of the IEES as approved by the participants of the general meeting, August 13, 2006. |
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Signature: __________________________________________
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