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Membership Application (via Fax or Mail only)

Please complete, print out a copy and either fax or mail  to the International Association of Nanotechnology Conference Office at the address given below. If you wish to pay by credit card online, please use the Online Membership Application Form

Title (Dr/Prof/Mr/Ms Mrs.)  
First Name   
Last Name  
Job Title  
Organization  
Street Address
City
Zip Code/Postcode  
Country  
Telephone  
Fax  
Email  @
 
 

 

Annual Membership Fees (in US$)  

 
Corporate Membership:

Industry
Corporate Gold Membership $2,995.00
Industry Corporate Silver Membership $1,595.00
Industry Corporate Membership $995.00

 Individual Membership

Industry Membership $295.00
Government & Non-Profit Organization Membership $225.00
Academic Membership  $195.00
Retired Professional Membership $55.00
Student Membership $45.00
Special Student Membership $25.00 (from a developing country)

 

 
* Your existing Membership ID number (for renewal)
 

 

Three Simple Ways to Pay (please select one)    
 1. Check In US Dollars, drawn on a bank in the USA and made payable to :  International Association of Nanotechnology.
2. Bank Transfer
Organizations paying by bank transfer must add $15.00 to the total payable to cover transaction charges levied by the bank. The delegate's name must be quoted on the draft and a copy sent to IANT. If you are paying via bank/wire transfer you will need the following information for a direct Bank Transfer to our account:
Beneficiary:  International Association of Nanotechnology
Bank of America
7707 Laguna Blvd
Elk Grove, CA 95758 USA
Routing Number: 121000358

Account Number : please contact us via email at info@ianano.org or by telephone at 1-916-529-4119 for the Account Number.

  
 3. Credit Card
 
NOTE:

To pay by credit card, complete the form, print out sign and either fax or post to the address shown below.

Should you wish to pay online with secured protection, please use the Membership Online Application.

 

Type of card (select one):
American Express
MasterCard
Visa

Name of Cardholder


Card Number



Expiry Date (mm/yy) /

Your Signature:

 

 ............................................................................................

 PLEASE PRINT FORM AND FAX OR POST TO:
  • FAX TO:   1-916-244-7029
  • POST TO:
International Association of Nanotechnology
2386 Fair Oaks Boulevard
Sacramento, CA 95825
P.O. Box 231823
Sacramento, CA 95823 USA

  • MEMBERSHIP QUERIES:  please contact IANT Membership Manager at:
    1-916-529-4119 or membership@ianano.org
 

 

 

 
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2003-2005  International Association for Nanotechnology. All rights reserved
International Association of Nanotechnology, Inc.
2386 Fair Oaks Boulevard
Sacramento, CA 95825 USA   
Tel. 916-529-4119   Fax. 916-244-7029

Email: info@ianano.org