Correspondent form

APPLICATION FOR AN URSI RADIOSCIENTIST

Please fill in this form (on screen), print it, sign it and return it to the URSI Secretariat at the address mentioned below.
This form can be downloaded

The undersigned has not attended the New Delhi General Assembly (October 2005) and wishes to remain/become an URSI Radioscientist in the 2006-2008 triennium (period 1 January 2006 - 31 December 2008).
A subscription to the Radio Science Bulletin is included in the fee.

Title : First name and middle initials :
Family Name :
Present job title :
Years of professional experience :
Professional affiliation :
Company name :
Department :
Street address :
City and postal/zip code :
Province/State : Country :
This is my
Phone (+ext.) :
Fax :
E-mail :

Areas of interest : (Please tick)

A_Electromagnetic MetrologyB_Fields and WavesC_Radiocommunication Systems and Signal ProcessingD_Electronics and PhotonicsE_Electromagnetic Noise & InterferenceF_Wave Propagation & Remote SensingG_Ionospheric Radio and PropagationH_Waves in PlasmasJ_Radio AstronomyK_Electromagnetics in Biology & Medicine
Scientific Committee on Telecommunications

The fee is 50 Euro.
(The URSI Board of Officers will consider waiving the fee if a case is made to them in writing.)

Method of payment : VISA / MASTERCARD (we do NOT accept cheques!)
Credit card No
Exp. date

Date : Signed

Please fill in this form (on screen), print it, sign it and return it to :

The URSI Secretariat
c/o Ghent University / INTEC
Sint-Pietersnieuwstraat 41
B-9000 GENT
BELGIUM
fax (32) 9-264 42 88

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