Membership application Prefix ( ❏ Prof. ❏ Dr. ❏ Mr. ❏ Ms.) First Name _____________________________________ M.I. ______ Last Name ______________________________________ Company __________________________________________________ Job Title ________________________________________ Mailing Address _____________________________________________________________________________________________ Please specify: ❏ Home ❏ Work City ___________________________________________ State or Province ___________________________________________ Postal Code/Zip + 4 ______________________________ Country __________________________________________________ Telephone # ____________________________________ Fax #_____________________________________________________ E-Mail __________________________________________ ❐ IAFP occasionally provides Members’ addresses (excluding phone and E-mail) to vendors supplying products and services for the food safety industry. If you prefer NOT to be included in these lists, please check the box. memberships Us $ 50.00 Canada/mexico $ 50.00 international $ 50.00 ❏ iAFp membership (Member dues are based on a 12-month period and includes the IAFP Report) Optional benefits: ❏ ❏ ❏ ❏ Food Protection Trends Journal of Food Protection Journal of Food Protection Online All Optional Benefits – BEST VALUE! Add $ 60.00 Add $150.00 Add $ 36.00 Add $200.00 $ 75.00 $170.00 $ 36.00 $235.00 $ 90.00 $200.00 $ 36.00 $280.00 ❏ student membership (Full-time student verification required) $ 25.00 $ 25.00 $ 25.00 Optional benefits: ❏ ❏ ❏ ❏ Student Membership with FPT Student Membership with JFP Student Membership with JFP Online All Optional Benefits – BEST VALUE! Add $ 30.00 Add $ 75.00 Add $ 18.00 Add $100.00 $ 45.00 $ 95.00 $ 18.00 $135.00 $ 60.00 $125.00 $ 18.00 $180.00 sUsTAiNiNG memberships ❏ GOld ❏ silver ❏ sUsTAiNiNG Recognition for your organization and many other benefits. $5,000.00 $2,500.00 $ 750.00 Contact the IAFP office for more information on the Sustaining Membership Program. Payment must be enclosed for order to be processed • US FUNDS on US BANK ❏ Check Enclosed ❏ Visa ❏ Mastercard ❏ American Express ❏ Discover * TOTAL MEMBERSHIP PAYMENT $ _____________ CREDIT CARD # _________________________________________________________ CARD ID # _________________________ExP. DATE __________________________ SIgNATuRE _____________________________________________________________ * All prices include shipping and handling Prices effective through August 31, 2010 Visa, Mastercard and Discover: See 3-digit Card ID number on the back of the card after account number. 4 eAsy WAys TO JOiN phONe +1 800.369.6337; +1 515.276.3344 FAX +1 515.276.8655 mAil 6200 Aurora Ave., Suite 200W Des Moines, IA 50322-2864, uSA Web siTe www.foodprotection.org 252 FOOD PROTECTION TRENDS | APRIL 2010http://www.foodprotection.org http://www.foodprotection.org