INDIVIDUAL MEMBER APPLICATION FORM EPS represents over 100 000 physicists in 39 countries in Europe. By joining the EPS as an Individual Member, you can have a direct voice in shaping European science policy. Moreover, with colleagues in your specific field of interest, Individual Members contribute to scientific excellence in physics. Individual Members also benefit from reduced conference fees at EPS conferences, receive Europhysics news and special prices for other physics journals. more than ideas > www.eps.org Application for Individual Membership 1 Personal details (please write in capital letters) Title .......................................................................................................................................... Last Name ................................................................................................................................ First name(s) .................................................................................................................... Name of institution .......................................................................................................... Date of birth .................................................................................................................... Nationality ................................................................................................................................ Full address (please indicate home or professional) .................................................................................................................................................................................... .......................................................................................................................................................................................................................................................................................................................... Postcode ............................................................................................................................ Country ........................................................................................................................................ Office phone .................................................................................................................... Home phone .......................................................................................................................... Fax ............................................................................................................................................ Email .............................................................................................................................................. 2 Professional details Institution ............................................................................................................................................................................................................................................................................................ Current position ............................................................................................................................................................................................................................................................................ 3 Type of membership Are you a member of one of the societies listed on the back page? If you are a member of one of the national member societies or collaborating societies listed on the back page, tick yes below and pass to section 4. Otherwise, tick no and pass to section 5. Ì Yes Ì No 4 Which society are you a member of? ................................................................................................................................................................................................................ 5 Address for correspondence (if different from address given in section 1) Address ................................................................................................................................................................................................................................................................................................ .......................................................................................................................................................................................................................................................................................................................... Postcode ............................................................................................................................ Country ........................................................................................................................................ > www.eps.org 6 EPS Directory The EPS has an electronic directory. Would you like to be listed? Ì Yes Ì No (if yes please indicate below which information you would like to appear) Ì Office Phone Ì Fax Ì Email Ì Postal Address Ì Name of Institution 7 Payment details Please tick the appropriate box: Ì I am a student enrolled in a physics course (send a copy of your student I.D. card) annual membership fee Û 14.70 Ì I am a pre-university teacher (send a certificate signed by the head of your establishement) annual membership fee Û 14.70 Ì I am a member of a national member society annual membership fee Û 19.60 Ì I am a member of a collaborating society annual membership fee Û 39.20 Ì I am not a member of a national member society or a collaborating society annual membership fee Û 58.80 Please choose your preferred method of payment (tick the appropriate box) Ì Upon receipt of an invoice Ì By cheque payable to European Physical Society (please add 7 Û for handling charges) Ì By Eurocard/Mastercard or Visa credit card (please complete your card details below) Ì Eurocard/Mastercard charge authorisation Ì Visa credit card charge authorisation I authorise the EPS to charge my account in the amount of .................................................................. Û (enter an amount) Card number Expiry date: (mm/yy) .............. / ................ Cardholder’s name (please print): ........................................................................................ Cardholder’s signature: Name .............................................................................................................................................................. Address .................................................................................................................................................................................................................................................................................................. .......................................................................................................................................................................................................................................................................................................................... Signature Date and place please return this form to: EPS • 6, rue des Frères Lumière • BP 2136 • F-68060 Mulhouse cedex • France Please tick the following Divisions, Sections and Interdivisional Groups which you wish to join Divisions & Sections Ì Astrophysics Ì Environmental Physics H Gravitational Physics Ì High Energy & Particle Physics H Solar Physics Ì Nuclear Physics Ì Atomic & Molecular Physics Ì Physics in Life Sciences H Atomic Spectroscopy (EGAS) Ì Plasma Physics H Chemical and Molecular Physics H Beam Plasma and Inertial Fusion H Electronic & Atomic Collisions H Dusty & Colloidal Plasmas Ì Condensed Matter Ì Quantum Electronics & Optics H Electronic & Optical Properties of Solids Ì Statistical and Non-Linear Physics H Liquids H Low Temperature Physics H Macromolecular Physics Interdivisional Groups H Magnetism Ì Accelerators H Semiconductors & Insulators Ì Computational Physics H Structural & Dynamical Properties of Solids Ì Experimental Physics Control Systems H Surfaces & Interfaces Ì History of Physics Ì Education Ì Physics for Development H Pre-university Ì Technology Group H University National Member Societies Albanian Physical Society Albania Lithuanian Physical Society Lithuania Armenian Physical Society Armenia Society of Physicists of Macedonia Macedonia Austrian Physical Society Austria Moldovan Physical Society Moldova Belarusian Physical Society Belarus Netherlands Physical Society The Netherlands Belgian Physical Society Belgium Norwegian Physical Society Norway Union of Physicists in Bulgaria Bulgaria Polish Physical Society Poland Croatian Physical Society Croatia Portuguese Physical Society Portugal Czech Physical Society Czech Republic Romanian Physical Society Romania Danish Physical Society Denmark United Physical Society of the Russian Federation Russian Estonian Physical Society Estonia Federation Finnish Physical Society Finland Physical Society of Serbia and Montenegro Serbia and French Physical Society France Montenegro Georgian Physical Society Georgia Slovak Physical Society Slovakia German Physical Society Germany Society of Mathematicians, Physicists and Astronomers of Hellenic Physical Society Greece Slovenia Slovenia Eötvös Lorand Physical Society Hungary Spanish Royal Society of Physics Spain Icelandic Physical Society Iceland Swedish Physical Society Sweden Royal Irish Academy Ireland Swiss Physical Society