Please complete and return this application to:
iSCAN
c/o Science Section
RDS
Ballsbridge
Dublin 4
Organisation
(if applicable):
...............................................................
Name / Representatives:.................................................................
Address: .............................................................................................
...............................................................................................................
...............................................................................................................
Tel: ...........................................................
Fax: .................................
Internet / e-mail address: ...............................................................
Membership type: (select one)
Ordinary (€ 40) - open to Irish science centres / visitor attractions / museums, etc.
Individual (€ 20) - open to individuals who do not meet the criteria for ordinary membership
Commercial (€ 80) - open to firms / suppliers / consultants
Student (€ 10) - open to full-time students
Payment (due 1 February):
(select one)
I enclose the membership fee for 2006
Please send me an invoice for 2006
Signature:.....................................................
Date:..........................
Note: Payment can be made by cheque or bank draft (sterling accepted).
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