Application form

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Application form

  1. 1. 1 More than one option possible (check all that apply). WORLD’S POULTRY SCIENCE ASSOCIATION APPLICATION FOR MEMBERSHIP Family name + initials : Sex: M F Given name : Date of birth: Titles : Prof Dr Drs Ir Ing Address Members can choose if they want to receive the Journal at their home address or company address. In case of the use of the company address the name of the company/university must be filled. Company/University : Address : Zipcode : Town : Prov./State : Country : Telephone : Fax : E-mail : Wants to join the : Branch per / / 20 Membership type : Affiliate Individual Member Student Life Member Journal : Online Print Online & Print No Journal Field of study1 : Administration Diseases Economics Genetics Hatching Management Housing Nutrition Products Discipline1 : Physiology Immunology Pathology Species of animals1 : Chicken Duck Geese Guinea Fowl Ostrich Quail Turkey Please return this completed form to your Branch Secretary. If there is no WPSA Branch in your country, or if you do not know who the Branch Secretary is, return the completed form to the Association Secretary: WPSA PO Box 31 7360 AA Beekbergen The Netherlands E-mail: wpsa@xs4all.nl www.wpsa.com

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