ICKL MEMBERSHIP

Payment in US Check (US dollars)

Please make sure you fill all the fields. We are regularly updating our membership database and we appreciate to have all members’data again.

We ask that you renew your membership and provide payment before April 15, 2020. 

Name	First Name	
Address		
		
City, Zip Code, 	Country	
E-Mail	Phone #	
Nationality	Year of Birth	
Profession/Affiliation		
Date	

Check as appropriate 

MEMBERSHIP 2020

O	Regular fee 1 Year	50 US Dollars

O	Student fee* 1 Year	35 US Dollars

* Student - please enclose a copy of your current student ID

Payment 

O	I include a check (check cashable on US banks only) payable to ICKL.	

Form to return to Treasurer US
	Mara FRAZIER, 
	119F Thompson Library, 
	1858 Neil Avenue, Columbus, OH 43210, USA
	Email: treasurer-us@ickl.org