Please fill in this form, and send by Airmail.

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Membership Application

Name

                                                                                    
Sex [Male] or [Female] @
Birth Day/Month/Year @@@@@@
Home address @

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Home telephone number @
Home Fax number @
E-mail @
URL of your homepage  on the Internet (if you have) @
Present occupation, and if affiliated with an institution, your position @
Institution's name @
Institution's address @

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Institution's telephone number @
@ Institution's FAX number @
Education @

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Degree and Qualification @
Professional organizations of which you are a member @
Specialty Fields @
Your interesting fields in parapsychology @
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Your Interest for our society @
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Sending address from JSPP [Home] or [Institution] @

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Name of a member of JSPP if you've asked him to recommend you @