Membership Application Form

Please provide the information requested and send your 2004-2008 membership dues payment of US$30.00 to Dr. Carol Lovatt , Secretary/Treasurer, International Society of Citriculture, Department of Botany and Plant Sciences, University of California, Riverside, CA 92521-0124 USA iscucr@ucr.edu

ISC Member Number |___|___|___|_ - _|___|___|

Surname     _____________________________________________

Given name___________________________________________

Affiliation____________________________________________________

Address_______________________Box # _______________

City __________________________Province/State _________________

Country_______________________Postal Code_____________________

Telephone ____________________FAX ___________________________

Email_________________________

Check here if you DO want your e-mail address to appear on the ISC website.

Please check all that apply:

New Membership Renewal/Reinstated Member Address/ Information update Delete from the ISC mailing list

Check here if you DO NOT want to receive the ISC Newsletter by e-mail.

METHOD OF PAYMENT (payable to International Society of Citriculture):

Check (drawn on U.S. Bank / U.S. Branch of foreign bank)

International Money Order

Master Card VISA Diners Club JCB Card

(Expiry date{MMYY} |__|__|__|__|)

Card #: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

 

Signature (Signature required )_____________________________________________