IMAGE SOCIETY: Membership Application Form

IMAGE SOCIETY
MEMBERSHIP APPLICATION FORM

Memberships are for one calendar year and are not prorated for any part thereof.

Print this Form using your web browser.

 
Title (Mr. Ms. Dr. Col. etc.): 

Name (First MI Last): 

Job Title/Position:

Organization:

Mailing Address:

City: 

State:

Zip+4 Code:

Telephone No:

Fax No:

Email:

Web URL:


CIRCLE  ONE OF THE FOLLOWING:
$50 - Individual Membership (United States)
$65 - Individual Membership (NON-US)
$25 - Student Membership (United States)
$40 - Student Membership (NON-US)




Send this completed application form along with payment 
(draft, check, money order, etc.) in US Dollars
payable on a US BANK to:
 
The IMAGE Society, Inc.
PO Box 6221
Chandler, AZ 85246-6221




Thank you for joining the IMAGE Society.
We hope you will become an active participant 
in the Society's events and programs.

IMAGE SOCIETY MEMBERSHIP APPLICATION FORM

IMAGE SOCIETY
MEMBERSHIP APPLICATION FORM