Full name: ________________________
Last Degree: _____________ Field(Major): _____________ Date: ___________________
Specialty: _______________ Home address: _______________________________________
________________________________________________________________________________
________________________________________________________________________________
Email Address: _____________________________________________ Phone:_____________
Work Address (or University): __________________________________________________
Duty: ___________________________ Work Experience: ________________
Membership requested: regular[ ] student[
] associate[ ] organization[
]
Amount Enclosed*: ______ Rials
______ US$
Date of request: ______________
A copy of current student id is needed for student members.
Payment in Rial:
Deposit your payment in Rial to the account # 54308205 Bank of Tejarat,
College branch (branch code: 183) in the name of CSI and enclose your deposit
receipt.
Payment in in US$
Send along the money order in the name of CSI.
* Those residing outside Iran must pay in US$.
cut here: