Full Membership Dues for 2013 US$150.00 Dues Structure Dues are calculated using a 3-tier system according to the World Bank Figures. Members based in countries where the Purchasing Power Parity (PPP) is less than US$3,000 paying a nominal fee of US$10; members in countries where the PPP is between US$3,001 and US$8,000 paying US$25; and all other Full Members paying US$150. We would also ask you to consider donating to the Solidarity Fund at this time. The fund is important in supporting members in developing countries to play an active role in the activities of IBE, where lack of available funds would otherwise prevent this. Upon completion of your payment transaction you will have the opportunity to make a donation to the Solidarity Fund if you wish. PLEASE ENSURE THE FORM BELOW IS COMPLETED IN FULL Association Name* Contact Person* Address Telephone +* Fax + Your Email* Website + _______________________________________________________ Please complete this section to confirm that your association still meets the criteria for Full Membership: "We confirm that we have not made any changes to the objectives or constitution of our organisation during the past twelve months that would alter the conditions under which our association was originally accepted as a Full Member of the International Bureau for Epilepsy." _______________________________________________________ First Name* Given Name* Male Female Position in Association* Check this box if you do NOT permit use of images from your association on the IBE website photo gallery No Date* PLEASE SEND FORM BEFORE MAKING PAYMENT MAKE PAYMENT NOW: Click on the Pay Now button and you will be taken to a secure site. You can make payment using a PayPal account or by using any major credit card.