Membership Application Form

(Print out and mail to, or fill out and email as attachment to)

Institute On World Problems

313 Seventh Ave.,  Radford VA 24141, USA

Email: gmartin@radford.edu,   Fax 540-831-5919

Web Page:  www.wcpa.biz

 

   Name (please print)_________________________________  Signature________________________________

   Occupation________________________________________________________________________________

   Address:  _____________________________________________ City________________________________

   State/Province__________________________________________ Post Code___________________________

   Country__________________________________________  Phone___________________________________

   Email_______________________________ Fax______________________ Web________________________

   Organization_______________________________________________________________________________

   Position__________________________________________________________________________________

   Organization phone:_______________________________ Fax_______________________________________

         Web:_______________________________________ Email:_____________________________________

 

   Membership dues:

         Developed countries:             $30.00                                          Developing countries             $5.00

         Developed countries (student):         $15.00                                Developing counties (student)         $2.00