Thank you for your interest in joining the CIOS! To do so by credit card, please complete and fax the following to 518 887 5186. (Note: you must complete the email procedure described at the bottom of this form in order for your registration to be completed. Please do so as soon as possible.)

Please print very clearly in large letters or type:

  Annual rates:

  a. For those who are not members of CIOS affiliate institutions:

          ____ US$50  -- professional membership

  b. For those who are members of CIOS affiliate institutions:

          ____ US$45  -- professional membership

My registration cannot be activated until I perform the email
procedure described at the bottom of this form

          ____ yes I understand


Name:   ______________________________________

Mailing address:    _________________________________________
                    _________________________________________
                    _________________________________________
                    _________________________________________
                    _________________________________________
                    _________________________________________


Email address:      _________________________________________
Phone number:       _________________________________________


                    ____ I would like to purchase a personal copy of
                         the ComIndex software system for US$50.00
                         For more information, see:
                         http://www.cios.org/www/comindex.htm


Credit card type:   ____  Visa
                    ____  Mastercard
                    ____  Discover Card
                    ____  American Express

Card number:        _________________________________________

Card
Expiration date:    __________________


Signature:          _________________________________________

(Please note: we cannot accept credit card payment unless this
registration sheet is signed and faxed.)

If you haven't already done so as part of the registration process you must send an email message to Comserve@cios.org so that the system can create a user record. A good first message is:

Place that text in the body of the email by itself.

Phone:  518 887 2443 (v)
        518 887 5186 (fax)

Email (CIOS online office):   support@cios.org
WWW service:                  http://www.cios.org
Email command interface:      Comserve@cios.org

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