| (please check) | Mr. O Mrs. O Ms. O |
| Title | _____________________________________ |
| First Name | _____________________________________ |
| Family Name | _____________________________________ |
| Private Adress | _____________________________________ |
| Postal Code, City | _____________________________________ |
| Country | _____________________________________ |
| Phone | _____________________________________ |
| Fax | _____________________________________ |
| Email | _____________________________________ |
| | |
| Membership fees | (please check appropriate circle) |
| ---ordinary members--- | O US$90* if paid with credit card or cash |
| ---ordinary members--- | O US$40* if not subscribed to journal Ecological Engineering |
| ---low salary countries--- | O US$45* if paid with credit card or cash |
| ---low salary countries--- | O US$10* if not subscribed to journal Ecological Engineering |
| ---students--- | O US$50* copy of valid student ID is required |
| ---students--- | O US$10* if not subscribed to journal Ecological Engineering |
| | * If paid by check: plus US$5 |
| Note | The journal can only be subscribed for whole calendar years. Please indicate when you want your membership to begin: O 2009
O 2010 |
| | |
| Method of payment | O Cash |
| | 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 |
| | O I enclose a check (plus US$5 per year) |
| | O please charge membership fee to my credit card
o American Express
o Mastercard/Eurocard
o Visa |
| Card Nr. | ___________________________________________________ |
| Cardholder's Name | ___________________________________________________ |
| Expiration Date | ___________________________________________________ |
| CVC2/CVV2 (last 3 digits in signature field) | ___________________________________________________ |
| | |
| 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. |
| | Signature: __________________________________________ |
