Name of the member______________________________________________________________

                     (LAST)                 (FIRST)              (MIDDLE INITIAL)

Dues are set at 100 EUROS for the time being (August 2006)

METHOD OF PAYMENT

O Bank Draft, Money Order or Certified Check drawn in US funds, payable to 
  ISAP (mail only; be sure to print your name on the Bank Draft)

O Credit Card: Visa  or Master Card (in US $)

CARD Brand (circle one:  VISA -  Master Card)

Card Number _________________________ Exp. Date (mo./y.) _____ / ______

Cardholder Name ______________ Cardholder Sign. _______________________

Please, introduce any change you wish compared to what is presently in ISAP 
membership database (to view your entry in the data base, go to 
<http://www.isap.org/membership_list.htm#index> and key your name in; 
provide a copy of the output in case of need of special corrections)

Salutation________________ (Dr, Prof., Mrs, Ms, Mr, ...)

Date of birth (optional)_________________________________(month day year)

Highest academic degrees_________________________________

Position_________________________________________________

Affiliation:_____________________________________________(laboratory)

            _____________________________________________(department)

            _____________________________________________(Univ., Hosp., Comp.)

Address:________________________________________________ (building/room)

        ________________________________________________ (street address)

        ________________________________________________ (PO or local mail box)

        _________________________________________________(city; Zip/postal code)

        _________________________________________________(state/province)

        _________________________________________________(country)

If you wish your mail to be sent to another address, please give it hereunder and state
whether that address can be included in the public ISAP membership list.

          ______________________________________________________________

          ______________________________________________________________

          include in public ISAP membership list: Yes /No

Telephone: ___________________(direct; please state country code and city code)

           ___________________(secretary)

           ___________________(main institution switchboard)

Fac-simile ___________________

E-mail address__________________________________________(please, spell legibly)

Internet Web site_________________________________________________________

Present major activities in Anti-Infective Pharmacodynamics/Pharmacokinetics

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Send or fax it to: 

ISAP Secretariat
Congress Care
PO Box 440
5201 AK 's-Hertogenbosch
The Netherlands
fax +31-73-6901417
mail j.vandermeer@congresscare.com