Name

Position

Department

Institution

Street Address 1

Street Address 2

City

Post code

Country

Telephone No.

Fax No.

E-mail address

I wish to renew the following membership Please select what type of membership you wish to renew... Personal membership for current year (€50) Personal membership for this year and next year (€100) Corporate membership for current year (€1000) Academic Institution Membership - AIM - Europe (€200) Academic Institution Membership - AIM - Rest of World (€250) Library Subscription Service - LSS - Europe (€250) Library Subscription Service - LSS - Rest of World (€300)

I wish to renew my membership by: select payment method bank transfer credit card

Invoice No.: (as printed on your membership invoice)

Credit card type: Please select credit card type... AmericanExpress MasterCard Visa Cardholder's name:

Card No. (max 16 characters - no spaces) Expiry date: month 01 02 03 04 05 06 07 08 09 10 11 12 / year 2008 2009 2010 2011 2012 2013 2014

Please note that we cannot guarantee the security of transmission of contents of forms sent through our website. If you would prefer to print out your submissions for this form and fax them to the SUERF Secretariat - please print this page and fax it to: +43 1 40420 7298