2019 Individual Membership form

* mandatory field


PERSONAL INFORMATION

Title:*
First Name*
Family Name*
Gender Female       Male
Year of birth*
Affiliation*
Position
Department
Please indicate it as "Department of ..."
PhD Student Yes       No

ABOUT SSD AND TEACHING ACTIVITIES

Do you belong to a "Settore Scientifico Disciplinare"*? Yes       No

If yes: Please indicate which one(s):
SSD di appartenza:
SSD di abilitazione:

Please indicate the course(s) you are teaching in the academic year 2018/2019:


INTERESTS

Main fields of Interest(max 3):


CONTACT DETAILS

Address*
Post code*
City*
Country*
E-mail:*
Url:
Telephone:
(country code) (city code) (Number) (Extension)
Mobile:
(country code) (Number)
Fax:


(country code) (city code) (Number) (Extension)


PRIVACY PROTECTION AND MEMBERSHIP DIRECTORY

Having read the privacy policy of this website:

With regards to the processing of my personal data for the operations necessary to enable the management of my membership with IAERE and related formalities

I consent
I am aware that, without my consent, IAERE cannot process my membership application and related formalities.


With regards to the inclusion of my contact details in the IAERE mailing lists

I consent           I do not consent
I am aware that, without my consent, IAERE cannot include my email address in the IAERE mailing lists aiming at circulating infomation about the Association activities.


With regards to the inclusion of my identification and contact details in IAERE online membership directory (full details will be available just to the members. On the public site we will just indicate your name, affiation and country):

I consent           I do not consent
I am aware that, without my consent, IAERE cannot disclose my personal data.


IAERE STATUTES

I accept IAERE Statutes
Yes
I am aware that, without my consent, IAERE cannot process my membership application and related formalities.


MEMBERSHIP CATEGORY

  Annual
2019
Triennial
(2019-2021)
Standard € 80.00 € 216.00
Reduced (**) € 20.00 € 54.00

 

** Reduced registration fees apply to students only, who are requested to prove their status by e-mailing to iaere@iaere.org one of the following: a copy of their Student ID Card 2017/2018; a note from their department on letterheaded paper; or the URL of the webpage run within the official website of their department in which they are mentioned as students will be required.


PAYMENT

I wish to pay via:

Credit Card
Bank Transfer

 

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