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How to Join

Print the following registration form, complete it and return it to the address given. All members are encouraged to interface directly with the PMP members.

REGISTRATION FORM

I hereby endorse the Erice and Farnesina Statements, and the Lausanne Declaration, and wish to become a member of the World Federation of Scientists.

Signed this ……………………………., in …..…………….

Signature

Name ……….………………………………………………..

Title ………………..……………………………………….

ORGANISATION / INSTITUTE

Name:…………………………………………………………………………………………………

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Address …………………………………………………………………………………………………

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Telephone No:   General  ……………………………..…..     Direct :……………………………

Fax No: …………………………….………..  e - mail: …………………………………………….

 

PRIVATE ADDRESS :

………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………….

Tel/Fax. No. : ……………………………..…  e - mail:……………………………………………..

I prefer to be contacted at q my place of work q my home address, by …………………..

I am particularly interested in the following Planetary Emergencies: ……………………………

………………………………………………………………………………………………………………….

I am enclosing a:

Return this form to:

World Federation of Scientists
CERN - LAA Experiment
Building #29
CH-1211 Geneva 23
Switzerland