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Comparative Parasitology 67(2) 2000 - Peru State College

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Name:<br />

MEMBERSHIP APPLICATION 271<br />

APPLICATION FOR MEMBERSHIP<br />

in the<br />

HELMINTHOLOGICAL SOCIETY OF WASHINGTON<br />

(Please Type or Print Legibly)<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/department):<br />

Phone: _<br />

E-Mail:<br />

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

Fields of Interest:<br />

FAX:<br />

If you are established and experienced in your field, would you consent to be a reviewer for<br />

manuscripts submitted for publication in the Society's journal, <strong>Comparative</strong> <strong>Parasitology</strong>l If so,<br />

what specific subject area(s) do you feel most qualified to review?<br />

Signature of Applicant Date<br />

Signature of Sponsor (a member)<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 for domestic active members and US$28 for foreign<br />

active members) to the Corresponding Secretary-Treasurer, Nancy D. Pacheco, 9708 DePaul Drive,<br />

Bethesda, MD, U.S.A. 20817.<br />

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

Credit Card: Visa® Q MasterCard® H Expiration Date:<br />

Credit Card Number: O CH d dl I II II I<br />

Signature of Card Holder:<br />

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

Date<br />

Amount Charged: US$<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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