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Comparative Parasitology 68(2) 2001 - Peru State College

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292 COMPARATIVE PARASITOLOC7Y, <strong>68</strong>(2), JULY <strong>2001</strong><br />

APPLICATION FOR MEMBERSHIP<br />

in the<br />

HELMINTHOLOGICAL SOCIETY OF WASHINGTON<br />

(Please Type or Print Legibly)<br />

Name:<br />

Mailing Address:<br />

Present Position and Name of Institution (If you are a student, write "Student" and indicate the<br />

degree you are working for and the university and department):<br />

Phone: FAX:<br />

E-Mail:<br />

Highest Degree Earned and the Year Received:<br />

Fields of Interest:<br />

May the Society publish your mailing address, phone and fax numbers, and e-mail addresses in its<br />

membership directory listing on the web site? If not, what information should be withheld?<br />

Signature of Applicant Date<br />

Signature of Sponsor (a member) Date<br />

Mail the completed application along with a check (on a U.S. bank) or money order (in U.S.<br />

currency) for the first year's dues [US$25 (<strong>2001</strong>) or US$30 (2002) for domestic active members<br />

and US$28 (<strong>2001</strong>) or US$33 (2002) for foreign active members] to the Corresponding Secretary-<br />

Treasurer, Nancy D. Pacheco, 9708 DePaul Drive, Bethesda, MD 20817, U.S.A.<br />

If you wish to pay by credit card (Visa or MasterCard only), please complete the following:<br />

Credit Card: EH Visa® D MasterCard® Expiration Date: /<br />

Credit Card Number: 0000 DODO DODO DODO<br />

Signature of Card Holder: Amount Charged: US$<br />

Printed Name Exactly as <strong>State</strong>d on Card:<br />

Helminthological Society of Washington Home Page: http://www.gettysburg.edu/shendrix/helmsoc.html<br />

Copyright © 2011, The Helminthological Society of Washington

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