INDEPENDENT MEMBERS / STUDENTS APPLICATION FORM 2015 WITH A CONNECTION TO THE INDUSTRY Mr. Mrs. Ms. First name: Last name: Address: Postal Code: City: Country: TelephoneFax E-mail Web Company: Position in the Company: Institutions Info Categories Organizations No. of votes at the GA Eligible to a position on the board Annual fee Voting members Members not entitled to vote at the General Assembly No with a connection to the industry cannot votes no Euro 100 CONDITIONS OF MEMBERSHIP Payment of subscription Membership will become effective upon receipt of membership dues. Membership The membership year runs from 1st January to 31st December. Membership is automatically renewed each year : Unless IH&RA has been notified by registered letter to the IH&RA headquarters of a request to terminate the membership by 30 September of the preceding year. Provided that all sums due to IH&RA, including in particular the annual subscription with respect to the current financial year, have been paid in full. Accordingly, if notice of resignation is not received by IH&RA headquarters by September 30 of the current year, the annual subscription for the year commencing on January 1st of the following year shall be due. I agree to terms and conditions Upon confirmation you will be redirected to PayPal to enter in your credit card information. A PayPal account is not required to make a credit card payment.