Membership Renewal Form

Member Renewal

For dues renewal – please complete the form below. When you click submit, you will be transferred to a PayPal site for dues payment. You do not need a PayPal account to complete payment – select the “pay with credit card” option to pay with your card. You will receive a receipt from PayPal.

Dues are for the 2020 year.

Congratulations in another exciting ICP year!

Are you a:

Renewing Member
New Member

First Name *

Last Name *

Email *

Preferred Mailing Address: Street/PO Box

Address Line 2

City

State or Province

Postal Code

Country

Name of your Work / Educational Institution (where you are currently active)

Membership Category

Topics of Interest

In the next section we would like you to tell us about your interests so we may contact you for relevant Interest Group activities. For each topic please check yes if you are interested in this topic.

Health and Wellbeing

Leadership

Human Rights

Migration / Refugees

Climate Change

Gender Issues (Incuding violence against women)

Write in Other Topic for Interest Groups (1)

Write in Other Topic for Interest Groups (2)

Add other topics for interest groups

2021 Dues

$0.00

When you click the "submit" button below you will be taken to a Paypal gateway. You can pay via Paypal OR via credit card. Select "pay as guest" to use a credit card. Alternatively, you may check the box below to pay via bank transfer. If you prefer bank transfer click the link "return to merchant" on the PayPal page.

Payment Method

Comment

Member Renewal

Topics of Interest

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