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POD Network Membership Form

Federal ID#: 52-1139670

Name and Mailing Information

Name:
Title:
Department/Unit:
Institution/Organization:
Mailing Address:
City:
State/Prov.:
Postal Code:
Country:
Work Phone:
FAX:
Email:

POD Membership Dues (Please indicate membership desired):
(All fees in U.S. dollars)

Regular

$95

Institutional*

$225

International

$110

International/Institutional

$240

Retired/Student

$45

International Retired/Student

$50

Membership Amount: (please calculate total)

* Institutional membership covers 3 individuals from the same institution. Please provide complete information, as above, for all members in the space provided below. Additional persons can be added to the institutional membership for $75 per person/$85 per person for international membership. Additional member information can be provided on an extra sheet. Individuals named for institutional membership do not have to attend the conference.  If you are enrolling more than 3 persons for the institutional membership, please send additional member information to us by email podoffice@podnetwork.org.

Please provide complete information, as above, for all members. 

Method of Payment

Purchase Order  Check (US Funds Only, payable to POD Network) Credit Card

Charge my VISA MasterCard

Card #:
Exp. Date:

Name as it appears on card:


For questions please contact:

The POD Network
 P.O. Box 3318
Nederland, CO 80466
Phone:  (303) 258-9521
Fax:  (303) 258-7377

Institutional Membership Form

Please add the names of at least two additional members to complete your POD institutional membership.

1. Name:
Title:
Department or Program:
Institution:
Address:
Phone:
Fax:
Email:

 

2. Name:
Title:
Department or Program:
Institution:
Address:
Phone:
Fax:
Email:

For questions please contact:

The POD Network
 P.O. Box 3318
Nederland, CO 80466
U.S.A
Phone:  (303) 258-9521
Fax:  (303) 258-7377
E-mail:  podoffice@podnetwork.org


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