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
20 euro for persons belonging to an EMS corporate member;
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:_______________________________________________
40 euro for persons belonging to an EMS reciprocity
agreement society but paying directly to EMS;
80 euro otherwise.