Location of registration

AMI Head office (Amsterdam)

Membership status

New Member Renewal

Prefix

Mr Mrs Ms

First Name

Middle Name

Last Name

Address

Postal Code / Zip Code

City

State

Country

Phone

Fax

E-mail

Comments

Type of membership

Individual Membership Fee for one year - Euro 40
Individual Membership Fee for three years - Euro 115
Individual Membership Fee for five years - Euro 190 (applicable to LIFE membership)
Life Membership - Euro 1100

Method of Payment

Cheque Bank Transfer Credit Card

Credit Card Number

Card Holders' Name

Card Type

For AMI Head office Visa Eurocard/Mastercard

Expiry Date

Card ID