For Thai Nationals - Name in Thai

The Siam Society Under Royal Patronage 131 Asoke Montri Road (Sukhumvit 21), Bangkok 10110, Thailand Tel: 0 2661 6470-7 Fax: 0 2258 3491 e-mail: [email protected] Office hours: 09:00-17:00 Tuesday to Saturday For all membership information visit www.siam-society.org/about/join.html

MEMBERSHIP APPLICATION FORM

TITLE (Please Tick ) FAMILY NAME:  MR  MRS  DR OTHERS (Please specify): GIVEN NAME(S):

FOR THAI NATIONALS - NAME IN THAI

NATIONALITY: DATE OF BIRTH:

NAME OF SPOUSE (your spouse will enjoy most of the benefits of membership):

MEMBERSHIP CATEGORY REQUESTED If student please specify college or university Please Tick One   Life  Ordinary  Student PREFERRED MAILING ADDRESS: RESIDENTIAL ADDRESS (if different from mailing address): Line 1 Line 1 Line 2 Line 2 Line 3 Line 3 Line 4 Postcode Line 4 Postcode Country Country COMPANY OR ORGANISATION: TITLE OR POSITION:

HOME PHONE: MOBILE PHONE: OFFICE PHONE: FAX:

E-MAIL ADDRESS: COMMUNICATION PREFERENCE:  e-mail  Post PUBLICATIONS REQUESTED: DIRECTORY OF MEMBERS:   The Journal of The Siam Society The Society occasionally produces a directory of members with  The Natural History Bulletin their mailing addresses and distributes it to all members. If you do not want to appear in this directory tick this box.

YOUR INTERESTS (for publication in the Member’s Directory) Please Tick  General  Agriculture  Anthropology  Archaeology  Cartography  Environment  Ethnology  Fine/applied arts  Folklore  History  Linguistics  Literature/drama  Music/dance  Numismatics  Philately  Public health  Sociology  Travel  Heritage conservation Natural History  Astronomy  Biology  Botany  Geology  Species conservation  Mineralogy  Zoology  Natural resource mgt. ASSISTANCE YOU CAN PROVIDE TO THE SIAM SOCIETY: Please Tick   Editing or writing publications  Leading Study Trips  Fund raising  Library  Organizing or conducting lectures and discussions  Advising or promoting natural heritage conservation (for example, preservation of traditional art or architecture, etc.) PAYMENT METHOD: Please Tick 

 Cash  Cheque  Bank transfer  MasterCard Visa

Payment by cheque Please make the cheque payable to "THE SIAM SOCIETY" Cheque number: ______Bank name: ______Branch: ______

By bank transfer Transfer money to: "THE SIAM SOCIETY" Thai Military Bank - Asok Branch Savings Account No. 053-2-03946-8 Please attach the docket to your application. Payment by credit card Please charge a total amount of ______Baht to my credit card account. Card number: ______. 3 digit security code: ______. Card expiration date: ______Name as on card: ______

Signature as on card: ______SIGNATURE OF APPLICANT: PROPOSER I recommend this applicant for membership in The Siam Society. Note: The proposer must be a member of The Siam Society in good standing and must be satisfied regarding the applicant's integrity and suitability for membership of the Society. DATE: NAME OF PROPOSER:

MEMBERSHIP NUMBER:

SIGNATURE OF PROPOSER:

BENEFITS OF LIFE AND ORDINARY MEMBERSHIP Access to The Siam Society Library Free addmission to The Siam Society Lectures and Exhibitions Discount on The Siam Society space rental, books, cards, and other items Eligibility to participate on Society study trips Free copy of announcements of Siam Society activities (to addresses in Thailand) Free copy of The Annual Report of The Siam Society The right to vote at the Annual General Meeting of the Society Free copy of The Journal of The Siam Society and The Natural Histoery Bulletin of The Siam Society (upon request) Free admission to the Kamthieng House Ethnological Museum

MEMBERSHIP FEES For persons in Thailand, the annual fee for ordinary membership is 3,500 baht, and the one-time fee for life membership is 50,000 baht. For persons outside Thailand, the annual fee for ordinary membership is US$ 115 and the one-time fee life membership is US$ 1,650.

Students up through the undergraduate level may become student members, paying and annual fee of 500 baht. Student members shall not be entitled to vote at Annual General Meetings. They do not receive The Journal of The Siam Society, The Natural History Bulletin or announcements of the Society activities. Corporatee memberships for business firms and other organizations are also available. The Society can provide details on request.