MEMBERSHIP APPLICATION FORM


Name :

Surname :

Title  :                               Mr/Ms

Address :

City  :                                     Postal Code :                          Country :

I would like to subscribe

[ ] as Institutional members  300 €  right to vote

[  ] as Supporting members  300 €  right to vote

[  ] as Affiliated members     150 €

[  ] as Individual members      50 €  (for 5 years 150 € )

 

Bank charges should be payed by the subscriber.

                                    signature                       date


Please send your remittance to the Treasurer of ICMAP

ICMAP Account (at moment since Sept. 2005)
Subaccount ICMAP   at
Crédit Lyonnais,  Paris Gericault
141 Avenue Mozart, 75016, Paris, France
under subaccount ICMAP
with the following Bank reference:
Banque: 30002 Indicatif:  00820
N° de compte: 5045 D
Clé: 15
IBAN: FR88 3000 2008 2000 0000 5045 D15
BIC: CRL YFRPP

Responsible: Talal Younes, General secr. Of IUBS (Internat. Union for Biological Sciences), Paris.



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