TYPES OF MEMBERSHIP
MEMBERSHIP BENEFITS
MEMBERSHIP FEES Individual membership Regular member (developed countries) – $35 Affiliate membership Libraries – $35 Please circle the type of membership you are applying for:
Please provide the following information: Organization name (only if applying as an affiliate member) ___________________________________________________ Main contact person ____________________________________________________________________________ Title _________________________________________________________________________________________ Address ______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Telephone ________________________________________ Fax _______________________________________ E-mail _______________________________________________________________________________________ Payment: Please charge my Visa or MasterCard (circle one) Credit Card number _______________________________________________________ Expiration date ___________________________________________________________ Name on card ____________________________________________________________ Signature _______________________________________________________________ Check, bank draft or money order enclosed Please return this form along with your payment (in U.S. Dollars) to: WORLD FEDERATION FOR MENTAL HEALTH |
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