If you want to receive hard copy,
please add an extra $ 20/euros 15 (incl. airmail postage) to
your Dues:
Please tick the appropriate boxes.
New
Member
Renewal
Change
of Address
Benefactor
US$ 200
Euros 152
Patron
US$ 100
Euros 76
Supporting
US$ 75
Euros 57
Institutional/Commercial
US$ 100
Euros 76
Regular
US$ 50
Euros 38
Student
US$ 25
Euros 19
Send
mailings to my
institution/business
Send to
my private address
Private Address
Last Name:
First Name:
Street Address:
City:
State:
Postal/Zip Code:
Country:
Phone:
Fax:
Email:
Institutional Address
Institution Name:
Street Address:
City:
State:
Postal/Zip Code:
Country:
Phone:
Fax:
Email:
Indicate your method of
payment:
MasterCard
Visa:
Card #:
Expiration date:
Signature:
Please add the code number found on the back of the card
Members NOT paying by credit card
North American
Members Please pay by check if possible. Make check
payable in US dollars to HNA,
drawn on a US bank. Send
completed form and check to
Kristin Belkin, 23 S. Adelaide
Ave., Highland Park, NJ 08904.
European Members Pay in your own currency
directly to Postbank
Berlin.
From Germany: a/c. no. 0744
146 108, bank no.:100 100 10
From other European
Countries: IBAN
(International Bank Account
Number) DE88 1001 0010 0744
1461 08 and BIC/SWIFT (Bank
International Code) PBNKDEFF
IMPORTANT! Those
European members paying by
bank transfer, complete and
send this membership/renewal
form to Fiona Healy, HNA
European Treasurer,
Seminarstrasse 7, D-55127
Mainz, Germany
