Join Lats

Membership Application Form

Active Member: US$ 40.00
Associate member: US$ 20.00

Name:
 
Last Name:
 
User:
 
Password:
 
Repeat Password:
 
E-mail:
 
Date of Birth:
 
Nationality:
 
Profession:
 
Institution:
 
Department:
 
Address:
 
City:
 
State:
 
Zip Code:
Country:
 
Phone:
 
Fax:
Position:
 
Home Address:
 
Home City:
 
Home State:
 
Home Zip Code:
 
Country:
 
Membership in Professional and Scientific Organizations:
1.
2.
Publications:
1.
2.
Sponsor:
1.
 
2.
 
Attention: Report on Sponsor 1 and 2, two names of active members of the SLAT so that your form can be analyzed by the Secretary .
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