Registration for the Aldous Huxley Society

c/o Prof. Dr. Bernfried Nugel
Englisches Seminar der Westfälischen Wilhelms-Universität
Johannisstr. 12-20
D-48143 Münster
Fax (for registration only): +49-2301-13968

Name: ......................................................................................................................
Address (office): .......................................................................................................
Address (private): .....................................................................................................
Phone (office): ................................................... Phone (private): ..........................
Fax (office): ...................................................... Fax (private): ................................
E-mail: .....................................................................................................................

(Please tick off where applicable)

I wish to become a regular / supporting member of the Aldous Huxley Society in accordance with its by-laws and would like to pay

• the minimum membership fee of € 40.00 p.a. as a regular or supporting member
• the minimum membership fee of € 25.00 p.a. as a regular member (student)
• an additional membership fee of € .......... p.a.
• I wish to make a single contribution to the amount of € ..........

Payment may be made either by cheque or directly to the account of the Aldous Huxley Society , Bank Account: No. 23861, BLZ 400 501 50; IBAN: DE68 4005 0150 0000 0238 61; SWIFT-BIC: WELADED1MST, Sparkasse Münsterland-Ost, Münster, Germany. If you pay by foreign cheque, please add conversion charges of € 4.00 at the current exchange rate.

Please forward your cheque to: The Treasurer – Aldous Huxley Society (at the above address).

• In return for my membership contribution I would like to receive a free copy of volume No. …… of "Human Potentialities" or volume No. …… of Aldous Huxley Annual.
• I wish to receive a copy of the by-laws of the Aldous Huxley Society in English / in German.
• I wish to receive a donation receipt.

Date: .................................................... Signature: .......................................................