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

  • 24 euro for persons belonging to an EMS corporate member
  • 36 euro for persons belonging to a resiprocity EMS coroporate member
  • 48 euro for persons not belonging to any corprorate member
  • 11 euro for an introductory fee

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:_______________________________________________