Membership application form

Please print, complete and return this form to:

Secretary PBBD
C/o Department of Biology
Faculty of Science
Universiti Brunei Darussalam
Tungku BE 1410
Negara Brunei Darussalam

Fax: 02-343074

�Note: Please do not send CASH in the post.�.

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Title: (Dr/Mr/Mrs/Miss)

Name:________________________________________________________________

Occupation:____________________________________________________________

(If you are a student, state which school/college/higher institute/university you are from)

Address:

_______________________________________________________________________

Phone:_______________________ Fax:___________________________________

E.mail:____________________________________

Annual subscription

Please tick ( / )

Professional $20(   )
Associate $20(   )
College/ higher institute/ university $15(   )
School $10(   )

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Updated by [email protected] on 03 April, 2001 Copyright � 2001  WebMaster Cosmic76