RILEM Membership Application Form

I would like to apply for RILEM membership and, accept that if awarded the membership, will be governed by Statutes, Bylaws, Statements of Policies and Procedures of RILEM. I authorise the release of my name as a member of RILEM, and information given in this form to other RILEM members. In accordance with the Convention established by the Council of Europe for the Protection of Individuals, I undertake to respect the rights of the members of RILEM whose addresses are listed in the directory published by the association. The right to access, as set forth in article 34 of French Law N° 78-17 dated January 6, 1978, can be exercised by contacting RILEM at the address above.

Full signature of the applicant (to be preceded by the hand-written note "Read and approved")

Date

Biodata

Prefix (Prof., Dr., Mr., Mrs., Ms., etc.) SURNAME/FAMILY NAME

First name Middle Initial

Organisation/Company

Postal address

State, province or county, where applicable

Zip/Postal code City

Country/Region

Tel Fax

E-mail (professional)

oMale oFemale

Date of birth (Year - Month - Day)

Mandatory for your registration

Preferred language for correspondence: oEnglish oFrançais

Can you read information both in English and French? oYes oNo

Activity: Annual report to be mailed to RILEM Secretariat General for Corporate Membership.

Professional Experience: to be attached for Individual Membership (detailed CV/ resume).

Membership that you are applying for:

Member Category / Your choice
(only one box ) / Member Category / Your choice (only one box )
/
Titular
/ / Senior
with subscription to the
print version of
Materials & Structures
Industrial /
Senior
with subscription to the online version of
Materials & Structures
Associate
/
Affiliate
Student

(1) tick the box corresponding to the category for which you qualify. See the Membership Benefits for complete description

To be returned to:

RILEM SECRETARIAT GENERAL – 157 rue des Blains, F-92220 Bagneux FRANCE

Tel.: +33 1 45 36 10 20 - Fax: +33 1 45 36 63 20 - E-mail: - http://www.rilem.org/join.htm

Details related to payment instructions will be supplied after acceptance of the applicant's candidacy.

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