The Helminthological Society of Washington - Peru State College

APPLICATION FOR MEMBERSHIP
in the
HELMINTHOLOGICAL SOCIETY OF WASHINGTON
(Please Type or Print Legibly)
Name:
Mailing Address:
Present Position and Name of Institution:
Phone:
FAX:
E-Mail:
Highest Degree Earned and the Year Received:
Are You a Student? If so, for what degree and where?
Fields of Interest:
If you are experienced in your field, would you consent to be a reviewer for manuscripts
submitted for publication in the Journal! If so, what specific subject area(s) do you feel
most qualified to review?
Signature of Applicant
Date
Signature of Sponsor (a member)
Date
Mail the completed application along with a check or money order (in U.S. currency) for
the first year's dues (US$25 for domestic active members and US$28 for foreign active
members) to the Corresponding Secretary-Treasurer, Nancy D. Pacheco, 9708 DePaul
Drive, Bethesda, Maryland, U.S.A. 20817
217
Copyright © 2011, The Helminthological Society of Washington