| FAMILY NAMES ..................................................................................................... |
| GIVEN NAMES ....................................................................................................... |
| ADDRESS: City ................................. Street .............................
N° ........................ |
| Postal Address:.....................................
Telephone N° ............................................ |
| University or institution of graduation (idate).............................................................. |
| .......................................................................................................................... |
| Titles or degrees ................................................................................................... |
| Further stidies ...................................................................................................... |
| .......................................................................................................................... |
| Otros scientific or professional background ................................................................ |
| .......................................................................................................................... |
| .......................................................................................................................... |
| .......................................................................................................................... |
| Name of institution or company of current enrolment ................................................... |
| .......................................................................................................................... |
| Position ............................................................................................................... |
| .......................................................................................................................... |
THIS SPACE FOR USE OF THE SOCIETY
BOARD |
| |
| INTRODUCED BY MEMBER.....................................
SIGNATURE ................................... |
| DATE OF RECEIPTION BY THE BOARD ........................................................................ |
| DATE OF APPROVAL BY THE BOARD .......................................................................... |
| Register N° .......................... Observations ............................................................. |
.............................................
APPLICANT'S SIGNATURE
There is an incorporation fee of $ 8.000.- plus a monthly
payment of $ 6.000.-, charging starts from date of application submitting.
Payment can be done direct in our postal address by check
, promissory note payable at sight or postal money order.
