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 2008:	__________
	US$35 New Membership for Developing Country Scientists:	__________
	Renewal Only Dev. Country Sci. US$35 for 2008:	__________
	US$30 for Students:	__________
	US$80 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
6517 S. 19th St.,
Lincoln, Nebraska 68512
Phone: 402-805-4748
Fax: 402-472-4687
For more information contact Dr. Heinrichs at eheinric@vt.edu