IAPL Membership Form

The following form goes directly to the IAPL Membership Coordinator Claire Goberman <membership@iapl.info>.   Credit Card Payments on-line are the fastest and most reliable method. 

Otherwise you must fill out the form,  print it, and then mail to:  Prof. Hugh J. Silverman, IAPL Executive Director, re: Memberships/ Registration, International Association for Philosophy and Literature, Stony Brook University, Stony Brook, NY 11794-3750 USA.  

Please fill out the following information and press the SUBMIT button. Do not confirm in the first box unless you are in fact paying Membership Dues and Registration.  Items with an asterisk (*) are required.



PAYMENT INFORMATION

     *Last Name
 
     *First Names
 
     *Position
 
     *Department
 
     *Institution
 
       Office Address #1
 
       Office Address #2 (Street)
 
       Office Address #3 (City)
 
       Office Address #4 (State/Province)
 
       Office Address #5 (Postal/Zip Code)
 
       Office Address #6 (Country)
 
       Home Address #1
 
       Home Address #2 (Street)
 
       Home Address #3 (City)
 
       Home Address #4 (State/Province)
 
      Home Address #5 (Postal/Zip Code)
 
      Home Address #6 (Country)
 
      Office Telephone
 
      Home Telephone
 
      Fax
 
 *E-Mail (make sure this is correct since  most IAPL communications are via e-mail.
 
 *Re-enter your E-mail here (just to be sure)
 
 *Where do you want us to send regular mail?  Enter either "Send to Home Address" or "Send to Office Address."
 
 

ANNUAL DUES 

(Dues cover one year beginning January 1st)  US $ 45/ Regular Members; US $25/ Retired Members; US $25/ Student Members


 
*Enter year(s) for which you are paying dues.
 
IF you have already paid IAPL 2002 dues, enter "IAPL 2002 dues already paid" [if this is not correct, your registration will not be valid].
 
IF you are a New Member, enter "New Member"
 
IF you are renewing your membership, enter "Membership Renewal"
*ENTER TOTAL AMOUNT OF DUES PAYMENT IN US$
 
 

*METHOD OF PAYMENT

 

  
IF you are mailing your payment (not recommended), include Check/Money Order (payable to "IAPL" in US $)  Enter Amount of Payment, Date of Check, & Check Number
Credit Card Payment - type of card:

VISA, M/C,  AMEX     
Amount authorized (US$)
Credit Card Number
Expiration Date:
Authorizing Signature: [enter your name as on your card]
Date of Credit Card Authorization
   

You have now completed this form.  Make sure that all your information is correct.  Once you press the SUBMIT botton, your form will be delivered to the Membership Assistant.  The CLEAR botton will erase all information and you will have to start again.

You can always contact Claire Goberman at <membership@iapl.info> if you have any questions about your payments.
 

Return to IAPL 2002 Conference Forms