EASST

EUROPEAN ASSOCIATION FOR THE STUDY OF SCIENCE AND TECHNOLOGY

2005 MEMBERSHIP FORM

Membership is from January 1 to December 31 on an annual basis. The next EASST Review will be sent once payment for 2005 has been received.

NAME:

MAILING ADDRESS:

TEL: FAX:

E-MAIL:

YOUR WEBSITE ADDRESS:

YOUR INSTITUTION'S WEBSITE ADDRESS:

I GIVE PERMISSION FOR MY NAME AND E-MAIL ADDRESS TO BE LISTED ON THE EASST WEBSITE: YES NO (Please circle)

MEMBERSHIP RATES: (PLEASE NOTE DISCOUNT FOR MULTI-YEAR MEMBERSHIPS)

	ONE-YEAR MEMBERSHIP	TWO-YEAR MEMBERSHIP	THREE-YEAR MEMBERSHIP
INDIVIDUALS	EUR 35, USD 47	EUR 65, USD 88	EUR 90, USD 122
STUDENTS	EUR 25, USD 34	EUR 45, USD 61	EUR 65, USD 88
LIBRARIES	EUR 40, USD 54	EUR 75, USD 101	EUR 110, USD 149
INSTITUTIONAL	EUR 375, USD 507	EUR 725, USD 981	EUR 1075, USD 1455

EASTERN AND DEVELOPING COUNTRIES MEMBERSHIP RATES:

	ONE-YEAR MEMBERSHIP	TWO-YEAR MEMBERSHIP	THREE-YEAR MEMBERSHIP
INDIVIDUALS	EUR 20, USD 27	EUR 35, USD 47	EUR 50, USD 68
LIBRARIES	EUR 35, USD 47	EUR 65, USD 88	EUR 95, USD 128

MY MEMBERSHIP DUES HAVE BEEN PAID: BY BANK TRANSFER BY CREDIT CARD (Please circle)

SIGNATURE: DATE:

HOW TO PAY YOUR EASST DUES

Please note: We do not accept personal checks

By bank transfer, in the amount of EUR to bank account number 60.12.24.116 (ABN-AMRO) (bank giro: 135646); STICHTING SCIENCE DYNAMICS, Amsterdam. Please state your name on your payment form. Fees will be collected in Euros.

BIC: ABNANL2A; IBAN: NL27ABNA0601224116

By VISA or MASTERCARD, in the amount of EUR . Please complete the details below in BLOCK CAPITAL LETTERS. Please check that your information has been copied correctly before sending in form. Fees will be collected in Euros.

Visa/MasterCard Number:	Expiration Date:
Name as it appears on the card:	Billing Address:
Signature:	Date:

Please return this completed form to:

EASST/ Vanessa Dirksen, Faculty of Economics and Econometrics, University of Amsterdam, Roetersstraat 11, 1018 WB Amsterdam, The Netherlands. Membership forms can also be obtained through the EASST website: http://www.easst.net. For questions, please e-mail the secretariat at easst@pscw.uva.nl.