| Authorized Signature: _____________________ |
Date: _____________ |
| Name: __________________________ |
Title: ___________________________ |
| Organization: _________________________ |
Department: _________________ |
| Address:
________________________________________________________________ |
| City: _________________________ |
|
| State & County: _________________ |
Zip/Post Code: ___________ |
| Phone: ____________________ |
E-Mail: _____________________ |
Check/money order
enclosed. Check/Money Order # _______________ |
VISA/MasterCard/AmEx Charge: A/C #: ________________________________ Exp: ___ / ___ |
Make
your check payable to the Association for Asian Studies in US dollars drawn on a US bank
or by International Money Order. SEND TO: Association for Asian Studies, 1021 East Huron
Street, Ann Arbor, MI 48104 USA; Fax: (734) 665-3801. |