Environmental and Molecular Mutagenesis - Legacy Tobacco ...

Name
EMS-
ENVIRONMENTAL MUTAGEN SOCIETY
MEUBWSHIP APPLICATION
Last First Middle Initial Highest degree
Address
City State Zip or Postal Code Country
Affiliation, if above is home address Telephone
Membership Types :
Individual : $50 (U .S .A., Canada, Mexico) Patron : $1000
Individual : $68.00 (Foreign) Sustaining : $500
Couple : $65 (U .S .A., Canada, Mexico) ; $81 .50 (Foreign)
Student : $7 .50, $42 .50 with journal (U .S .A., Canada, Mexico) ; $60 .50 with
journal (Foreign)
Student sponsor's signature . (Student status must be documented each year .)
Each type of membership except the $7 .50 student membership includes a single
subscription to the Society's journal, ENVIRONMENTAL AND MOLECULAR MUTA-
GENESIS . Foreign subscriptions include partial payment of mailing costs .
Please make check payable in U .S. funds to the ENVIRONMENTAL MUTAGEN
SOCIETY .
Mail to :
ENVIRONMENTAL MUTAGEN SOCIETY
P.O. BOX 7925
BERKELEY, CA 94707-0925
http://legacy.library.ucsf.edu/tid/clb93d00/pdf
Signature
Date of Application
Membership and ENVIRONMENTAL AND MOLECULAR MUTAGENESIS subscription
are for the current calendar year, provided applications are received by July 1 of that
year, unless otherwise specified .