Membership and Renewal

Please, complete this form.

New individual membership Renewal individual membership number
New institutional membership Renewal institutional membership number

Personal Information

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Tariff (select one)

Professions For one year For two years Lifetime (**)
Volunteers
USD 15
USD 30
USD 350
Students
USD 15

USD 30

USD 350
Others Health Professionals
USD 25

USD 50

USD 350
Physician
USD 50

USD 100

USD 350
Institution
USD 100

USD 200

(**) The Lifetime members carries out an unique payment of US $350 and they maintain its membership of for life

Payments (choose one option)

Credit Card

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Transfer with Western Union

Addressee:
Ana Carolina Monti - Gerente Admnistrativa ALCP
Belgrano 141; (2900) San Nicolás; Bs. As. - Argentina

By cash