Name (Prof, Dr, Mr, Ms, etc.) __________________________________________________________________________

Institution ________________________________________________________________________________________

Address _________________________________________________________________________________________

Country ____________________________ Phone _______________________________

Fax _____________________________________

E-mail ___________________________________________________________________

I want to become a member of WMA. If I do not notify the president or treasurer by letter before the end of September of each year,
my membership is automatically renewed and the annual fee is due. The next fees are due on Oct. 1st for the following 12 months.

Please, charge my credit card annually on Oct. 1st for 41.90/36.70 EUR: Mastercard Visa
Card no _______________________________________________

Card name ______________________________________________________ Expiry date (month/year) /___/___/

I will transfer 40.00/35.00 EUR from an Austrian or other EURO account to: 'WMA - Werner
Wolf', P.S.K. Postsparkasse Wien, account no. 72 572 731, bank code number 60000; BIC: OPSKATWW;
IBAN: AT926000000072572731; 'WMA-membership 2002/03' (or later)

In these fees all transfer costs (where applicable) have already been included. If you choose any other means of transferring your fee to the WMA, please make sure that the WMA gets 40.00/35.00 EUR net.

Date /___/___/_____/ Place ________________ Signature ___________________________________