FOUNDATION FOR INTELLIGENT PHYSICAL AGENTS

c/o Me Jean-Pierre Jacquemoud
2, rue Bellot
CH-1206 Geneve
SWITZERLAND

Pro-forma invoice

Company/Organisation

 

Address

 

 

 

Headquarters City

 

Date

 

Membership Type

[   ] Principal

[   ] Associate

Membership Fee

 

Joining first Quarter

(July to September)

 

Joining second Quarter

(October to December)

 

Joining third Quarter

(January to March)

 

Joining fourth Quarter

(April to June)

…

CHF

 

[  ]  5,000

 

 

[  ]  3,750

 

 

[  ]  2,500

 

 

[  ]  1,250

 

,

USD

 

[  ]  3,000

 

 

[  ]  2,250

 

 

[  ]  1,500

 

 

[  ]     750

 

 

EURO

 

[  ]  3,000

 

 

[  ]  2,250

 

 

[  ]  1,500

 

 

[  ]     750

 

CHF

 

[  ]  1,750

 

 

[  ]  1,313

 

 

[  ]     875

 

 

[  ]     438

 

 

USD

 

[  ] 1,000

 

 

[  ]    750

 

 

[  ]    500

 

 

[  ]    250

 

 

EURO

 

[  ] 1,000

 

 

[  ]    750

 

 

[  ]    500

 

 

[  ]    250

 

 

Note: Please make sure that this payment is free of any bank charges.

Send payment to:

CBG-Compagnie Bancaire Geneve                       Account Number: 1.122'920
6 Rue de la Corraterie                                         Reference: FIPA
CP 5022
CH-1204 Geneva
Switzerland

When payment has been made please send this form to:

Ms. Jacqueline Kelly
FIPA Secretariat
1712 Oakmead Drive
Concord, CA  94520 – USA
Telephone: +1 925 680 2590
Facsimilie: +1 925 682 1922
Email: secretariat@fipa.org