Please PRINT THIS FORM and return it to the General
Treasurer in order to pay your
membership fee by CREDIT
CARD:
Prof. Esther REBATO, General-Treasurer EAA, Univ. del País
Vasco, UPV/EHU,
Fac. de Ciencias, Dpt. de Genética, Antrop. Física y Fisiol.
Animal,
Apdo. 644, 48080 Bilbao, SPAIN (Fax: +34 94 601.35.00)
Yearly membership fee: 22 EURO for regular members, 16 EURO for
student members
NAME OF EAA MEMBER: ..................................................................................(CAPITAL LETTERS, please)
COUNTRY OF EAA MEMBER: ............................................................................
I pay for 2007 ...., for 2008 ...., for 2009 ...., for 2010 ...., for 2011 ....., for 2012 .....
Please, tick the appropriate year(s)
TOTAL AMOUNT: ........ x .............. EURO = .............. EURO
Undersigned allows Prof. E. Rebato, General-Treasurer of the EAA, to be paid
the amount of .............. EURO (repeat the total amount, please)
TYPE OF CREDIT CARD: VISA ...., MasterCard ...., Please, tick the type of card,
No other credit cards, please.
CREDIT CARD NUMBER: / .... .... .... .... / .... .... .... .... / .... .... .... .... / .... .... .... .... /
NAME OF CARDHOLDER: ..................................................................................(CAPITAL LETTERS, please)
CARDHOLDER SIGNATURE: .............................
EXPIRATION DATE: ..... /..... /.....
* Student members should add a letter of their Professor
stating that they are under 30 years of age,have not
yet obtained a PhD (or
Doctorate), and have not been a student member of the EAA for longer than 5
years.