Membership and Renewal

Please, complete this form.

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

Personal Information

(* required fields)

*
*
*
*
*
*
*
*

Tariff (select one)

Professions For one year For two years (-20%) Lifetime (**)
Others Health Professionals
USD 25

USD 40

USD 350
Physician
USD 50

USD 80

USD 350
Institution
USD 100

USD 160

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

Volunteers (non profesional)
USD 15

USD 24

USD 350
Students
USD 15

USD 24

USD 350

Payments (choose one option)

Credit Card

Important.

This form is developed following the guidelines set by the merchant account companies in Argentina which are the ones responsible for the credit card transactions. In order to complete this form, you need to complete all the required spaces, regardless of the country you live in.

Expiration date (MM/YY): write expiration month and year with two digits each, for example: “May 2012” - “0512”

Identification Card or Document: corresponds to the different identifications cards that are commonly used in Argentina.

DNI: National Identification Document

CI: Cedula de Identidad

LE: Libreta de enrolamiento

LC: Libreta cívica

Use the Identification Card you use together with your Credit Card in your country and select the option DNI or CI. You may use your Driver's License number.

Birth date: DD/MM/YY: Write the day, month and year of your birth date in this order, for example: “26th of April, 1960” - “26041960

Bank transfer

Banco Santander Río
Sucursal: 188
Cuenta corriente en pesos Nº 004960-5
CBU: 0720 1888 2000 0000 4960 54
CUIT Nº: 30709510874

Banco Intermediario
STANDARD CHARTERED BANK
NEW YORK
Swift Code SCBLUS33XXX
ABA 026002561