Registration form

Registration Form for a New IACS-NAS Membership

Regd. Office: 4970 Olive Street, Unit 210

Montclair, CA 91763, USA

First Name

MI (optional)

Last Name

Phone

Academic Affiliation

Country

Birthday (YYYY-MM-DD)

Street Address

City

State/Province/Region

Postal/Zip Code

Country

Payment Method

PayPal Bank Transfer Stripe Zelle

Tier of Membership(required)

Lifetime member ($1000) Student/Trainee Member ($50/year) 1-year member ($100/year) 3-year member ($250/3 years)

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