Comparative Parasitology 68(2) 2001 - Peru State College
Comparative Parasitology 68(2) 2001 - Peru State College
Comparative Parasitology 68(2) 2001 - Peru State College
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
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