Please fill in this form, and send by Airmail.

Membership Application

	Name
	Sex [Male] or [Female]
	Birth Day/Month/Year
	Home address
	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
	Institution's telephone number
	Institution's FAX number
	Education
	Degree and Qualification
	Professional organizations of which you are a member
	Specialty Fields
	Your interesting fields in parapsychology
	Your Interest for our society
	Sending address from JSPP [Home] or [Institution]
	Name of a member of JSPP if you've asked him to recommend you