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Membership Application Form
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Member Information |
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English Name ________________________________Chinese Name: _______________ Expertise: _______________________________________________________________ |
Title ___________________________ Affiliation p SIZE="1">University p CommercialType: p Research Institute FACE="Monotype Sorts">p Government |
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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 $___________ |
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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: ________________________________________ |