Application for Individual Membership

I wish to become an individual member of the International Society of the Rorschach and Projective Methods. Please submit this request to the Membership Committee:

First Name, Middle Name:
Name:
Gender:Male  Female
Date of birth:
Mailing address:
Country:
E-mail:
Is there a national group or Rorschach Society in your country that is a member organization of the International Society of the Rorschach and Projective Methods?
Yes:  No:
If yes, are you a member of that organization?
Yes:  No:
If you are not a member, why not?

Education

Highest degree:
Year awarded:
Institution:
Field of study:

Employment

Employment (Current employment, dates. Graduate students: Enter name of university you are attending)
Do you currently hold a license or certificate to practice?
Yes:  No:
Have you attended an ISR congress?
Yes:  No:
If yes, where?

Payments / Conditions

  • Application fee: CHF 40.--
  • ISR dues: CHF 40.-- per year are payable within 90 days of the receipt of the dues invoice.
  • payable in international funds
  • Note: Applications without fee payment will be returned.

I wish to pay my application fee and dues by

check (enclosed)
credit card
  (if credit card, please specify which one)
  EUROCARD/MasterCard
  VISA card
    number:
    expiration date:

I certify the information provided above is accurate and correct.




Signature of applicant: _____________________________________________
Date: _____________________________________________

Please print this form and return it to:

Mrs Trudi Finger
Treasurer, International Society of the Rorschach
and Projective Methods
c/o Hans Huber Publishers, Hogrefe AG
Laenggass-Strasse 76
P.O. Box
CH-3000 Bern 9
Switzerland