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INSTITUTE OF MUSLIM MINORITY AFFAIRS
Membership 2007
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Name:______________________________________________________________________
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Mailing
Address:______________________________________________________________
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___________________________________________________________________________
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Telephone:______________________________
Fax:________________________________
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E-Mail
Address:______________________________________________________________
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Please
enroll me as a member of The Institute of Muslim Minority Affairs, London, U.K. Membership benefits
include subscription to Journal of Muslim Minority Affairs,
subsidized rates for publications under IMMA Book Series and information
on conferences and seminars sponsored by IMMA.
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1.
MEMBERSHIP:
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Check ( v )
appropriate box
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Dues
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(A)
Full Member
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US $ 60.00
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(B)
Student / Retiree
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US $ 38.00
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MEMBERSHIP DUES
PAYABLE:
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US $ ___________(1)
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2.
IMMA CONTRIBUTIONS:
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Fund
for Advancement of Minority Studies/Research
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US $ ______
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Fund
for Publication of IMMA Book Series
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US $ ______
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Soft
Currency Fund
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US $ ______
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TOTAL IMMA
CONTRIBUTIONS:
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US $ _________(2)
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3. GIFT MEMBERSHIPS:
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I
would like to send _____ number of gift membership/s at @ $ 60.00
each to the following:
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Name:
_________________________
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Name:
______________________________
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Address:
_______________________
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Address:
____________________________
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TOTAL FOR GIFT
MEMBERSHIP:
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US $ _________(3)
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4. TOTAL DUE:
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ADD (1), (2) AND (3)
FROM ABOVE: US $ _______________(4)
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______
Enclosed is cashier's check/international money order in the name of
Institute
of Muslim Minority Affairs
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______________
Please charge my:
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Access
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Visa
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Diners
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American
Express
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Master
Card
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Card
Account Number:_______________________________ Expiration
date:_____________________
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Signature:
_______________________________________________(mandatory for card authorization)
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