| Full Name: | ___________________________________________________________ | |
| (Last, First, MI) | ||
| Title/Position: | Dr./Mr./Mrs./Ms. _____________________________________________ | |
| Business: | ___________________________________________________________ | |
| Address: | ___________________________________________________________ | |
| ___________________________________________________________ | ||
| ___________________________________________________________ | ||
| Phone: | ___________________________________________________________ | |
| Fax: | ___________________________________________________________ | |
| E-mail: | ___________________________________________________________ | |
| Research Interests: __________________________________________ | ||
| ___________________________________________________________ |
Regular Membership Dues: $ 100.00 ___ |
Student Membership Dues: $ 25.00 ___ |
||||||
ISCA Regular Membership includes a subscription to our Journal, reduced rates on all conferences and proceedings, participation in the Society's activities and committees, waiver of journal page fees, and the right to vote and hold office.
Membership in ISCA involves an annual (January 1 through December 31, 2010) non-refundable fee.
METHOD OF PAYMENT: __ Check __ Money Order __ MasterCard __
Visa
Payment must be made by check or Money
Order (in U.S. dollars drawn on a U.S. bank made payable to ISCA).
Payment will also be accepted by credit card (MasterCard or Visa
only).
Credit Card Number: ___ ___ ___ ___ - ___ ___
___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___
Expiration Date: __________
Security Number on Back of Credit Card: _____________
Billing Street Address
__________________________ ZIP CODE of
Billing
Address _________________
Exact Name is it appears on card:
_________________________
Your Signature: ______________________________________
Please send completed form along with
your payment to:
ISCA - MEMBERSHIP 2010
975 Walnut Street, Suite 132
Cary, NC 27511-4216 USA
You may FAX the completed form to: (919) 467-3430
Questions?
Email: isca@ipass.net
ISCA's EIN NO: 56-1799522