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Payment Form
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(word) Download Payment Form
Notes
1. Please confirm that you have completed the "Membership Application Form" at:
http://www.apsce.net/RegisterMembership.aspx
2. Please complete this Payment Form and send by fax to +886-3-427-5336, Dr. Jie-Chi Yang,
or scan this form and email it to yang[at]cl.ncu.edu.tw.
3. A confirmation notice will be sent to your email account right after your payment is received.
4. APSCE reserves the right to approve, or refuse membership.
Personal Information
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First name:
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Last name:
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Affiliation:
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Country / Region:
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Email:
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Payment Details
We prefer to receive membership fees by credit card. If you prefer to pay by other payment methods, please
contact to Administrative Secretary Dr. Jie-Chi Yang at yang[at]cl.ncu.edu.tw.
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Credit Card Information
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Method of payment
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○Visa
○MasterCard
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Name on the card
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Expiry date: Month
Year
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Card Number
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__________ －__________ －
__________
－ __________ －
__________*
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Membership fee |
○US$60(Member)
○US$20(Student) |
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Amount
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US$ __________ (please fill in the amount)
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Signature
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Date:
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*Security Code: Credit cards
have 3 extra numbers on the back.
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