Please complete, print out a copy and either fax or
mail to the International Association
of Nanotechnology Conference Office at the
address given below.
If
you wish to pay by credit card online,
please use the
Online
Membership Application Form
Title (Dr/Prof/Mr/Ms Mrs.)
First Name
Last
Name
Job Title
Organization
Street Address
City
Zip Code/Postcode
Country
Telephone
Fax
Email
@
Annual Membership Fees (in US$)
Corporate
Membership:
Industry Corporate Gold Membership $2,995.00
Industry Corporate Silver Membership $1,595.00
Industry Corporate Membership $995.00
Individual Membership
Industry Membership $295.00
Government & Non-Profit Organization Membership
$225.00
Academic
Membership $195.00
Retired Professional Membership $55.00
Student Membership $45.00
Special Student Membership $25.00 (from a developing country)
*
Your existing Membership ID number (for renewal)
Three Simple Ways to Pay
(please select one)
1.
Check
In US
Dollars, drawn on a bank in the USA and made
payable to : International
Association of Nanotechnology.
2.
Bank Transfer
Organizations paying by bank transfer must
add $15.00 to the total payable to cover
transaction charges levied by the bank. The
delegate's name must be
quoted on the draft and a copy sent to IANT.
If you are paying via
bank/wire transfer you will need the following information for a direct
Bank Transfer to our account:
Beneficiary: International Association of Nanotechnology
Bank of America
7707
Laguna Blvd
Elk Grove, CA 95758 USA
Routing Number: 121000358
Account Number
: please contact us via email at
info@ianano.org or by telephone at
1-916-529-4119 for the Account Number.
