Classification Society of North America / Membership Form

· A subscription to the Journal of Classification

· Discount registration fees at the annual CSNA meeting

· The Classification Literature Automated Search Service (SERVICE) on CD

· Newsletters of CSNA and IFCS by e-mail

DUES (circle the amount being paid):                        2006 & beyond

                                            2004   2005    (per year)

Regular member (receive all publications)    $80    $80    $80

Retired regular member (receive all pubs)    $60    $60    $60

Student member (receive all pubs)            $20    ---    ---

For members of the IFCS member societies:

  Affiliate member (receive J. Class. only)  $60    $60    $60

(Please PRINT, at most 30 characters per line.)

Name__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Address line 1 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Address line 2 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

City ___________________________ State/Province _______ Postal Code: _______________

Country _________________

If change of address, check here: _____

E-mail address(es): _________________________________If change, check here: ______

If a directory is published, do you want to be listed ?Yes_____No _____

Total amount of dues enclosed: _________ For year(s): ________

I am enclosing a check (in U.S. currency only, drawn on a U.S. bank), payable to the Classification Society of North America: _____

I am paying with a charge card: VISA: _____ MasterCard: _____

For charge card payments only:

Card Number: ___ ___ ___ ___  - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___

Expiration Date (mm/yy): ___ ___ / ___ ___

Authorization Signature: _______________________________

Please send by regular mail to: