APPLICATION FOR INDIVIDUAL MEMBERSHIP


1. Name:

First name(s):

Date of birth:

Nationality:

Address:

Address:

Address:

Address:

Address:

 

(Please remember the zip and country codes.)

 

2. Professional status (position, institution, specialisation)

 

Highest academic degree:

 

3. Areas of interest:

(Please use 2000 Mathematics Subject Classification.)

 

4. Are you a member of a society/organisation which is itself a corporate member of the E.M.S.? Please check attached list.

YES

NO

5. If your answer to question 4 is YES, to which corporate member do you belong?

 

 

6. Address for all correspondence (if different from address under 1.)

 

 

Date and place:

 

Signature:

 

 

The EMS individual membership fee is

22 euro for persons belonging to an EMS corporate member;
44 euro for persons belonging to an EMS reciprocity agreement society but paying directly to EMS;
88 euro otherwise.

Name:__________________________________________________

Address:________________________________________________

________________________________________________

________________________________________________

Credit card number:_____________________________________

Visa: __ Eurocard/Mastercard: __ American Express: __ Other: ________________

Expiration date:___________________________________

CVV/CVC (card verification number, last 3 digits on signature panel on the reverse side of the card):

______________

I am a member of the following EMS corporate member:

________________________________________________________

I am a member of the following EMS reciprocity society:

______________________________________________________

Total to pay: ___ euro

Date:_________________________________________

Signature:_______________________________________________