Membership Dues, International Association of Mathematical Physics

Please use this form iff sending dues to US Account

Date:

Name: 

IAMP Membership Number :

(Only needed if there is a chance that your name is not unique. Find it by clicking on your name at http://www.iamp.org/cgi-bin/iamp.pl)

Amount enclosed:

To cover dues for years:

email address:

(so we can acknowledge receipt of dues)

Please send this form together with check made out to IAMP to

Department of Mathematics
P.O. Box 400137
University of Virginia
Charlottesville, VA 22904-4137
USA