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CNS Membership Form
Join or Renew
Membership fees are annual and must be renewed each year. Membership payment can be made by credit
card, check, or wire transfer. Cash payment is also accepted at the annual meeting.
2015 Annual Membership Rates:
Student
Postdoc
Faculty
$25
$50
$65
Contact I nformation
Last name
First name
Middle initial
Organization
Street
Suite #
City
State
Daytime telephone
Fax
Zip/Postal code
Country
Email Address
Please indicate Membership type— Faculty Member (FM), Post Doc Member (PM), Student Member (SM), or Nonmember (NM) and the additional information
requested.
Last name
First name
Membership Level
Member/Account ID#
Membership &
Registration Type
Registration
Amount
$
$
Subtotal : $
Total Due : $
1|P age
Payment method
Check/money order
VISA
MasterCard
American Express
Discover
Card number (16 digits)
CCV
Expiration date
Billing Address
City, State
Zip Code
Printed name of cardholder
Signature of cardholder
Send this completed form and registration fees to:
CNS 2015 Registration
c/o TM Events, Inc.
2100 Valley View Pkwy #1526
El Dorado Hills, CA 95762
OR
Fax to: 916-293-9409
*Checks may be made out to “Cognitive Neuroscience Society”, please do not send cash
2|P age