| First Name: |
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| Last Name: |
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| Degree(s)/Academic rank/position: |
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| Institution/Department: |
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| Address 1: |
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| Address 2: |
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| City: |
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| State: |
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| Zipcode: |
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| Country: |
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Major type of work (i.e. research,
teaching, clinical/laboratory,
counseling, administration): |
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Areas of special interest: |
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MEMBERSHIP RATE
The PGDIS membership fee of $100 (U.S.) MUST be paid in
advance and is good for
two years.
The basic amount
includes PGDIS
membership.
Additional rates described below
can be added to the
basic fee
to include access
to RBMOnline web and print
publications.
Note: PGDIS is a non-profit organization, and additional optional
contributions will be
accepted
and donated to support PGD research.
PUBLICATION SUBSCRIPTIONS
PGDIS members are entitled to special rates for RBMOnline publications.
Web-only,
print-only
and combined web & print options are described below.
Subscriptions must
be paid in advance
with credit card or check. |
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PLEASE CHOOSE ONE OF
THE
FOLLOWING MEMBERSHIP PLANS |
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| Membership Plan Selection |
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| Details of the 7 membership options |
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* Two-year membership $100
(membership is a 2-year minimum) |
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* Membership plus 2-year web access $300
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* Membership plus 1-year web access $225
(2nd year, an addtional $150) |
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| * Membership plus 2-year print pubs. $500 |
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* Membership plus 1-year print pubs. $325
(2nd year, an additional $250) |
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| * Membership plus 2-year web & print $600 |
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* Membership plus 1-year web & print $375
(2nd year, an additional $300) |
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PAYMENT OPTIONS INCLUDE
CREDIT CARD OR CHECK
Please choose one: |
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| Name on Credit Card: |
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| Credit Card Type: |
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| Credit Card Number: |
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| Expiration Date: |
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Card Security Number:
(3-digit number on back of card) |
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| Total amount to charge to card: |
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| By Check: |
Make check payable to PGDIS
Mail to:
PGDIS
2825 North Halsted St.
Chicago, lL, USA 60657
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