Name:
Department:
Institution:
Address:
Phone:
Fax:
Email:
Degrees:
Title:
Area(s) of focus:
Amount
Enclosed
Regular Member
with Electronic Subscription only to Frontiers in Neuroendocrinology - $70.00
without Frontiers Subscription - $40.00
with Print and Electronic Subscription to Frontiers - $110.00
Fellow Member In-training
(Post-doctoral fellows, residents and others in post-graduate programs; Requires documentation from program)
with Electronic Subscription to Frontiers - $50.00
without Frontiers
Subscription - $20.00
with Print and Electronic Subscription to Frontiers - $80.00
Student Member
(Requires nomination by Regular Member)
with Electronic Subscription to Frontiers
- $40.00
without Frontiers Subscription - $10.00
with Print Subscription to Frontiers -$70.00
Sponsor's signature if student member: Signature:
________________________________
Emeritus Status
(Retired Regular Member)
without Frontiers Subscription - $20.00
with Print and Electronic Subscription to
Frontiers - $90.00
Member's Signature:
Please make checks in USD payable to: American Neuroendocrine Society
and return your payment to:
Dr. Susan Wray
Secretary,
American Neuroendocrine Society
Cellular & Developmental Neurobiology Section
NIH, NINDS
Building 35, Room 3A-1012
Bethesda,
MD 20892
NOTE: Check must be received by February 3,
2006 to be eligible for Member rates at ICN2006.
| Return to the ANS Home Page. Mail comments and questions to Dr. Susan Wray |