AVS Student Membership Gift Form
(Yes I would like to give an AVS 2019 Student Membership to the following student for $40)
contact information
:
Student First Name
:
Student Last Name
:
Name of School:
Address:
Address2:
City:
State:
Postal Code:
Country:
Phone:
Fax:
E-Mail:
please provide the following information:
Divisions:
***Divisions***
Advanced Surface Engineering
Applied Surface Science
Biomaterial Interfaces
Electronic Materials & Photonics
Magnetic Interfaces & Nanostructures
Nanometer-scale Science & Technology
Plasma Science & Technology
Surface Science
Thin Film
Vacuum Technology
Major:
***Major***
Biology
Biophysics
Chemistry
Electrical Engineering
Engineering (Not EE or ME)
Mechanical Engineering
Materials Science
Optic Management
Physics
Other
Year of Highest Degree
:
Expected Graduation Date
:
method of payment:
(STUDENT GIFT OF $40.00)
Check
(Make payable to AVS in U.S. dollars and drawn on a U.S. bank,
AVS Tax ID No: 04-2392373
)
AMEX
MasterCard
VISA
Card Number
Cardholder Name
Expiration Date
CCID
Name of Person Giving Gift: