Fax, Mail, E-mail, Phone Join-Renew-Donate


Please print or copy this form, complete it (or call us), and send to:

International Cultic Studies Association
PO Box 2265, Bonita Springs, FL 34133, USA
mail@icsamail.com
FAX: 1-305-393-8193
PH:  1-239-514-3081


Name

 

If your credit card uses a different address from the one where we should mail publications, please include both addresses, noting which is for the credit card.

Address

 

Address 2

 

City/ State (Province) / Zip (Postal Code)

 

Country

 

Phone/Fax

 

E-Mail

 

Payment Method

[     ] Check (payable to ICSA; US dollars only)     [     ] Visa          [     ] MasterCard

CC Info

Number:                                                                                                  

Exp. Date:

Security Code (on back of card): 

Membership

Member: $75 - $99 per year.  Supporter: $100 - $999 per year. Patron: $1,000 + per year (see Member benefits).  Web Member: $55 per year.  Student Web Member: $25 per year.

$

Donation

Please be as generous as possible.

Tax receipts available upon request.

$

Total

 

$

   
   
ICSA engages no professional solicitors. FL No. SC-07158; Federal tax-exempt No.: 04-2667-828. A copy of this organization’s official registration and financial information may be obtained from the Division of Consumer Services by calling toll free within the state. 1-800-HELP-FLA (435-7352). www.floridaconsumerhelp.com.