Membership Form

date (yyyy/mm/dd)
title:
first name & initial:
family name:
institution/company:
department:
address (note: only saves 4 rows, 60 columns each) unit/street
city:
province/state:
country:
postal/zip code:
phone:
fax:
e-mail:
Membership Type [FEE](check only one) Individual [$ 30 / 2 years] Student [$ 15 / 2 years] Institutional supporter [$100 / 1 year] Institutional trustee [$200 / 1 year]
comments (note: only saves 6 rows 70 columns each) This form does not yet work. To join the CISR, please print this form & mail to (please include a check made out to "Canadian Institute for Synchrotron Radiation" for fee payment with application): CISR c/o Department of Physics and Astronomy University of Waterloo 200 University Avenue West Waterloo, Ontario, Canada N2L 3G1