Application for
Annual Individual Membership
in IAPPS

(COPY THIS FORM, COMPLETE, AND MAIL TO THE ADDRESS BELOW)

Dr. ____ Prof. ____ Mr. ____ Ms. ____ Other ________

________________ Family name

_________________ First name

_____ Middle initial

Institutional Address:
________________________________________
________________________________________
________________________________________
________________________________________

Discipline: __________________ E-Mail Address: ________________

Fax Number: _______________Telephone Number: ______________

Basic Annual Membership Fee(1): (check as appropriate)	US$50 New Membership for Industrialized Country Scientists:	__________
	Renewal Only Industrialized Sci. US$50 for 2012:	__________
	US$35 New Membership for Developing Country Scientists:	__________
	Renewal Only Dev. Country Sci. US$35 for 2012:	__________
	US$30 for Students:	__________
	US$100 additional for subscription to print version of journal Crop Protection:	__________
TOTAL COST OF MEMBERSHIP INCLUDING PRINT VERSION OF JOURNAL IF SELECTED:		_________

Mail the completed form and a check in US dollars drawn on a US Bank to:

Dr. E.A. "Short" Heinrichs
Secretary General
Dept. of Entomology
University of Nebraska
Lincoln, NE 68583-0816
Phone: (402) 472-6011
Fax: 402-472-4687
For more information contact Dr. Heinrichs at eheinrichs2@unl.edu