Membership fees reduced to CDN $125 $110
for June '08 applications

APPLICATION FOR 2008 'RESEARCH ASSOCIATE' FELLOWSHIP

I hereby apply for election to Fellowship in the Occidental Institute Research Foundation (OIRF), as a Research Associate, under the statutes of that international nonprofit incorporated Society for practitioners of Biological Medicine. Enclosed, are my initiation and membership fees of CDN $125 for the calendar year of 2008.

THE FINE PRINT: I understand that the Board of Directors has the right to not accept my application, refuse to renew it for subsequent years, or cancel it at any time, by simply making an appropriate full or partial refund, should my conduct be (or have been) detrimental to the name of the Society, the OIRF, the field, or for any other reason. I shall not represent myself as being a staff member of Occidental Institute Research Foundation, nor a graduate of any past or present Occidental Institute program unless I really am one. Furthermore, I will not photocopy nor allow to be reproduced or dispersed in any manner the newsletters, publications or recordings of OIRF, and I agree to maintain ethical conduct and professional standards regarding the field and practice of Biological Medicine, during any term of affiliation in the Society. To this, I place my hand:

Signature _____________________________________ Date_____________

Name (Print) ____________________________________________________

Degree(s) ___________________ Licensed As_________________________

Address ________________________________________________________

City ____________________State/Prov. _____________ Country _________

Zip/Postal Code ___________ Phone Numbers ________________________

Fax Number ________________ E-Mail Address_______________________

/___/  Please send me e-mail announcements  /___/ Please do not send e-mail announcements

My specific areas of interest in the field of Biological Medicine are:

 _______________________________________________________

Payment method:

I am paying my 2008 initiation/membership fees totaling CDN $125 by the following means:

 /___/ Check or Money Order Enclosed

 /___/  Visa

 /___/  MasterCard

Credit Card Number ____________________________________________________ 

Your name as it appears on the credit card _________________________________ 

Signature ___________________________ Expiry Month/Year ___________

Overseas please add CDN $25 for Airmail shipping, or request electronic delivery in PDF format.

If paying by credit card, you can FAX this form to (250) 490-3348 in Canada.

Send check/money order to:
                   Occidental Institute Research Foundation (OIRF),
                   P. O. Box 100, Penticton, B.C. V2A 6J9 CANADA

For additional information phone (800) 663-8342 toll free in North America,
                   Or (250) 490-3318 in Canada on weekdays, 8:30 AM to 4:30 PM Pacific Time.