International Society for Stereology (ISS)   Individual membership application form

 

Title:.....Last name:.............................................................................................
First name:.........................................................................................................

Department:..................................................................... .................................

Institution:..........................................................................................................

Number/Street:...................................................................................................

City:......................................Country:...............................Postcode:....................

Phone..................... Fax:.................... email:......................................................

Field(s) of interest:.............................................................................................

 

Individual membership includes subscription to Image Analysis and Stereology Journal.

Please tick ONE category:

	Regular member	Student member
2010 membership	50 Euros	25 Euros
2010 and 2011 membership	95 Euros	50 Euros

 

Please tick ONE payment method :

- Bank transfer	Bank : CBC     Account owner : Int. Soc. Stereology SWIFT/BIC Code : CREGBEBB                                      IBAN : BE69 7320 1659 9478
- Credit card via Paypal	Please, contact mail@stereologysociety.org to receive an email with instructions

 

 

 

 

Signature and date:.........................

 

Please send, email or fax this application to:

Mrs. Nadia ELGARA Universite de Liege GeMMe Sart Tilman, B52 4000    LIEGE BELGIUM

or   FAX +32 - 4 - 366 91 98 or   mail@stereologysociety.org