MAC Membership Registration Form (English)

Contact Name*

First NameLast Name

Work Title*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

E-mail*

example@example.com

Additional E-mail

example@example.com

Organization Name

Organization Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Organization Website

www.example.com

Organization Website Address

Organization Description

Please check the appropriate membership category*

How do you wish to make payment*

Please review and save our Wire Transfer Instructions then complete your payment through your bank. Remember to also click SUBMIT below so that MAC receives your membership details.

Membership Options*

Individual MemberOne Year individual membership subscription to MAC

€50.00

Student /RetireeOne Year student/retiree membership subscription to MAC

€25.00

Institutional Member (1-5 staff)One Year Institutional membership subscription to MAC

€100.00

Institutional Member (5-10 staff)One Year Institutional membership subscription to MAC

€200.00

Institutional Member (>10 staff)One Year Institutional membership subscription to MAC

€300.00

Total

€0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration