ASOCIACION MEXICANA DE LA CIENCIA DE

LOS ANIMALES DE LABORATORIO A.C.

2002 New Membership Aplication - AMCAL

Name______________________________________________________________________

Company / Institution _________________________________________________________

Mailing Address______________________________________________________________

City_________________ State __________ Zip____________

Phone Number______________ Fax _____________E-Mail Adresss___________________

Date______________ Signature _________________________

2001 Membership rate: Canada / U.S.A. $ 72 dollars or equivalent in pesos

Note: Membership is for calendar year. Payment must be enclosed with this application. Individuals using a purchase order will be billed, however, the membership is not processed until payment is received.

Method of Payment: please indicate your method of payment.

______Check______ Money Order

Payment must be paid in USA dollars or equivalent in pesos from BANAMEX Bank ( account number 5418540895 ). Return this application form to:

Graciela Cabeza DVM

Instituto de Biotecnología de la UNAM .

Bioterio.

Av. Universidad 2001, Col. Chamilpa. Cuernavaca, Morelos. MEXICO, . C.P. 62210

or Post Office 27064 México, D.F.

For further information in Web Site: amcal2000.tripod.com