International Rural Network Membership Application Form

Individual Membership (Check One)

Membership dues are based on your annual salary calculated in US or Canadian dollars or British Pounds and are purchased for one calendar year. The membership year is January to December and invoices will be sent as a reminder early to mid year to those who have not automatically renewed. This applies to all categories.
If you are paying by credit card the payment will appear in Canadian Dollars, at the rate of exchange for the day processed, based on the US dollar amount.
Standard Rates Rates for Members of Qualified Regional Chapters, NGOs and Institutions
US $15, or £7.50 fee for personal income less than US $15,000 or £7,500 US $7.50, or £4 fee for personal income less than US $15,000 or £7,500
US $15  £7.50  US $7.50  £4 
US $35 fee for personal income between US $15,001 and $30,000 or £7,501 and £15,000 US $17.50 or £9 fee for personal income between US $15,001 and $30,000 or £7,501 and £15,000
US $35  £17.50  US $17.50  £9 
US $70, or £35 fee for personal income between US $30,001 and $60,000 or £15,001 and £30,000 US $35 or £17.50 fee for personal income between US $30,001 and $60,000 or £15,001 and £30,000
US $70  £35   US $35  £17.50 
US $110, or £55 fee for personal income between US $60,001 and $90,000 or £30,001 and £45,000 US $55, or £27.50 fee for personal income between US $60,001 and $90,000 or £30,001 and £45,000
US $110  £55  US $55  £27.50  
US $130, or £65 fee for personal income US $90,001 and over or £45,001 and over US $65, or £32.50 fee for personal income US $90,001 and over or £45,001
US $130  £65   US $65  £32.50 

Please fill the Following Details (in English only) :

 
First Name:
Last Name:
Email:
Phone:
Corporation / Institution Name:
Nationality:
Address:
City :
State :
Zip :
Country :
Methods of Payment: Paypal (payable to International Rural Network Inc.)
  Bank
  Cheque/Draft
Payment Details:
Enter the above Code: Refresh
  

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