Dues Form for 2005
Oklahoma
Chapter of the Society for Neuroscience
University Faculty: $20.00
Postdoctoral Fellows: $10.00
K-12 Teacher's: $10.00
Staff: $10.00
Students: $5.00
New Member____
Current Member______ (Only Information that is needed is contact information that has changed.)
Name:____________________________________________________
Affiliation:__________________________________________________
Position:___________________________________________________
Address:___________________________________________________
Telephone:_________________________________________________
E-mail:____________________________________________________
Checks should be made out to: Oklahoma Chapter of the Society for Neuroscience.
Please return this form with your payment to Dr. John Ash.
Dr. John Ash, Ph.D.
Ophthalmology
401 Dean A. McGee Eye Institute
608 Stanton L. Young Blvd.
Oklahoma City, OK 73104
tax id number: 731056939