EUROPEAN SOCIETY FOR PHOTOBIOLOGY MEMBERSHIP RENEWAL/APPLICATION FORM Please complete the form and send it to the Treasurer (by fax, mail or e-mail): Dr. Francesco Ghetti CNR Istituto Nanoscienze, NEST Piazza San Silvestro 12, I-56127 Pisa, Italy (Fax +39 050509550, E-mail: [email protected], Tel. +39 050509561) I wish to renew/apply for membership of the European Society for Photobiology (ESP) Family name: First name: Middle initial(s): Address: (Please use your institutional address. If you wish to receive the journal at a different address, please send this information on a separate sheet) Tel: Fax: Email: Please indicate your speciality below in order of preference, 1, 2, 3 (please NO MORE than 3 preferences) () Photochemistry, Photophysics () Environmental Photobiology () DNA damage and repair () Phototechnology, Spectroscopy () Chronobiology () Photocarcinogenesis () Photosensitisation () Photoprotection () Phototherapy, PDT () Photosynthesis, Photoconversion () Phototoxicity () Photodermatology () Photomorphogenesis () Vision () Photoimmunology () Photosensory Biology () Photomedicine () Other: If you do not wish your particulars to be included in the membership list on the ESP website (www.photobiology.eu), please tick the box I do not want my particulars to appear on the ESP website Membership fees in EUR The membership fee includes the subscription to the official journal of ESP Photochemical & Photobiological Sciences (published by the Royal Society of Chemistry (RSC), UK and available both in electronic and hardcopy versions). Please note that a subscription for 4 year guarantees you a fixed price as well as a reduction on a per year basis. ELECTRONIC VERSION of Photochemical & Photobiological Sciences Student member 2 years (please supply proof of studentship) 60 € Retired photobiologist 2 years 60 € Standardmember 2years 100 € Standardmember 4years 190 € HARDCOPY plus ELECTRONIC VERSION of Photochemical & Photobiological Sciences Standardmember1year 140 € Standardmember2years 275 € Standardmember4years 545 € Membership is for a calendar year, January through December. Please contact Francesco Ghetti ([email protected]) for any additional information about membership. METHODS OF PAYMENT 1. Credit card. Please fill in the details below. I, the undersigned authorise the European Society for Photobiology to debit my credit card: MasterCard Visa Card number Security code: Expiry date: For the sum of € Amount of € in words: Name of card holder: Signature of card holder: 2. Bank transfer. Bank Monte dei Paschi di Siena, Pisa Ag. 5 Branch, Via Borgo Stretto 40, 56127 Pisa, Italy Account name “ESP European Society for Photobiology”. Account number 0000002117.88. IBAN:IT65P0103014006000000211788 BIC/SWIFT:PASCITM1Y68 You must ensure that the bank includes your name and address so that the source of the payment can be easily identified. Please send a copy of the bank transfer to Francesco Ghetti (address above)..