IAP Membership Application

Membership Application for 2007 The annual membership fee of USD 140.00 (members in training and retired members: USD 100.00) includes the subscription to the official journal of the IAP, Pancreatology. For special arrangements for Japanese members, please contact: Prof. Keiko Shiratori, Department of Gastroenterology, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; Tel.: +81 3 3353 8111, Fax: +81 3 5269 7435, E-Mail: [email protected] Personal Details Family name First name

Middle names

Mailing address Phone

Fax

E-Mail Present hospital and/or medical school or other appointments

Membership category 첸 Regular

첸 Trainee (please enclose a statement of the Chief of your department)

Interest 첸 Clinical

첸 Research

첸 Retired

첸 Both

Payment Please charge the membership fee to my credit card 첸 American Express 첸 Diners 첸 Eurocard 첸 MasterCard 첸 Visa Card No.: Exp. date: Date/Signature: Please return this application to:

For all other inquiries, please contact:

S. Karger AG Attn. Mr. Peter Roth Allschwilerstr. 10 P.O. Box CH–4009 Basel Tel.: +41 61 306 1333 Fax: +41 61 306 1234 E-Mail: [email protected]

Prof. Dr. P.G. Lankisch Department of Medicine Municipal Clinic of Lüneburg Bögelstrasse 1 D–21339 Lüneburg (Germany) Tel.: +49 4131 77 2240 Fax: +49 4131 77 2245 E-Mail: [email protected]

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