IACL Membership Application


 


On-line application form

After you submit this application, you must remit payment to activate your membership.

Fields marked by '*' are required.
1. Name in Roman letters:
Last name / 姓: * , First name: *
2. Name in Chinese characters 中文姓名:
3. Mailing address in Roman letters:
* (street)
* (city / state / zip code)
* (Country)
4. Mailing address in Chinese, if applicable 中文住址:
5. Telephone @ work (including area code):
6. Telephone @ home (including area code):
7. Fax:
8. E-mail:*
9. Web site: http://
10. Institutional Affiliation:
11. Department Affiliation:
12. Interests and specializations:
13. Select one of the following account types: *
regular member ($30)
student member ($15)
life member ($300)
14. To access your account in the future, you need to create your own user name and password:
user name:* password:*
15. Security code:*

 


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Last Modified: July 4, 2013