2012
Membership Application Form
1ST January 2012 to 31ST DECEMBER 2012

All members will be registered as Individual Members and will receive the ESIS Newsletter, once a year.
Membership Fees should be paid by Bank Transfer to the value of €30 (Euros).
Please put a cross (X) in the appropriate box(es):

Register me as an ESIS member for the year 2012 and send the ESIS Newsletters to the address stated below (in BLOCK CAPITALS please).
Payment details.
Since the membership fee is exceedingly cheap, PLEASE REGARD THIS FORM AS AN OFFICIAL INVOICE, noting that on receipt of your payment you can receive an official receipt plus your ESIS 2009 membership number.

I pay my membership 1000,- CZK at “ASI Klub ESIS”, Brno, Czech Republic by bank transfer to ČSOB, account name: A.S.I. – Asociace strojních inženýrů, account number: 203875413 / 0300, IBAN: CZ19 0300 0000 0002 0387 5413, var. symbol:       (Your identification number).
OR

Other, please contact us for details.

Surname:	Initials:	Title(s):  	
Affiliation:	
Address:	
		
	     	
e‑mail:	Tel No:	
	Fax No:	

Please return this form to:

ESIS Secretariat - ASI klub ESIS
Prof. Ing. I. Dlouhý, CSc.
Ústav fyziky materiálů AVČR
Žižkova 22
616 62 Brno

Signature:
Date:      
For ESIS records purposes please give the numbers of the ESIS Technical Committees in which you are most interested (http://www.esisweb.org).
Technical Committee(s):