(ISIF Use) Customer No

____________________________________________________________________________________________________________________________

Membership Application Form
Please complete all items legibly to qualify. Mail this form with payment and resume to
Dr. Dongping Zhu, SCOBA, 3565 Rider Street, Suite A, Santa Clara, CA 95051

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Member Information


English Name ________________________________Chinese Name: _______________

Expertise: _______________________________________________________________

Title ___________________________

Affiliation p SIZE="1">University p Commercial

Type: p Research Institute FACE="Monotype Sorts">p Government

Affiliation ________________________________________________________________ Dept. ___________________________
Street Address ____________________________________________________________________________________________
City ________________________ State ______________________ Zip Code________________ Country _______________
Phone ______________________ Fax _________________________ Email ____________________________________________    
Declaration: I have read and will abide by the bylaws and rules of SCOBA. Name: _____________ Signature:__________ Date:_______
A. Payment Items: (US Dollars)

 

Annual Membership Fee for the Year ___________

 

Check the appropriate category and enter the amount below:

p Board Member p $200 per year

p Regular Member p $100 per year

p Student Member p $50 per year

(applies to full-time student only)

p Corporate Member p $500 per year

Total Membership Fees

$__________

B. Payment Options

(US Funds only, make check payable to Dongping Zhu. No credit card please.)

 

Signature:___________________________________________Date:____________

A. Membership fee $___________

B. Others (specify) $___________

Total payment $___________

C. For SCOBA Staff Use Only (do not write in the section)

Amount Received:_______________ Date Received: __________________

SCOBA Receiving Staff Signature:__________________________________

SCOBA Treasurer Signature: _______________________________________

Board Approval Signature: ________________________________________