IPSF Individual Membership Application

In order to become an IPSF Individual Member you must:

1. Be a pharmacy student or have graduated from a pharmacy degree within four

years. Note that the number of membership years requested is limited by
membership eligibility.

2. Complete the Individual Membership Application Form

3. Pay the membership fee. Fees are determined by the World Bank classification of
countries according to their Gross National Income (GNI) per capita to Low Income,
Lower Middle Income, Upper Middle Income and High Income countries.
Here you can check the classification of the country of your current residence:
http://siteresources.worldbank.org/DATASTATISTICS/Resources/CLASS.XLS

Please note that ONLY credit card payments and direct monetary transfers
will be accepted. No other form of payment will be processed.
Before making the payment please contact the IPSF Treasurer at treasurer@ipsf.org
to confirm the correct fee.
The membership fee amounts are in Euros (EUR).

Lower
Number of Low Upper Middle
Middle High Income
membership years Income Income
Income
1 20 25 30 35
2 30 40 50 65
5 60 80 100 130

Credit Card Payments

You must provide the following details:
• Credit card number
• Card type (Visa/Mastercard)
• Expiry date
• CVC code (last 3 numbers on the back of your credit card)

Alternatively you can also make the credit card payment through Paypal, please
contact Treasurer.

Direct Monetary Transfer

Transfer the total amount into the following IPSF account with your full name,
country and the letters ‘IM’ attached to the payment:

Beneficiary: International Pharmaceutical Students’ Federation

Account Number: 57.19.15.671
Bank: ABN AMRO
Bank Address: Postbus 11595
2502 AN Den Haag
The Netherlands

SWIFT Code: ABNANL2A

IBAN Code: NL05ABNA0571915671

The applicants must take care of all bank charges, and in addition add 7 Euros bank
fee to their fee.

Paypal
Paypal payment is also possible. Please contact IPSF Treasurer, treasurer@ipsf.org
4. Send the form electronically to IPSF Secretary General, secgen@ipsf.org. The
confirmation of the payment should be sent to IPSF Treasurer, treasurer@ipsf.org
Title: Mr Ms Mrs Miss

First Name:      

Family Name:      
Street address:      
City:      
Postal code:      
Country:      
Telephone /Mobile Number (including country code):      
E-mail Address:      
Languages Spoken:      
Are you a: Student Year of Graduation:
Intern Year of Graduation/Expected year of graduation:     
Graduate Year of Graduation:      
Individual Membership Request: 1 year 2 years 5 years

Method of Payment:

Credit card

Note that an administration cost of 6% of the total will be charged.

Name on credit card:

VISA MasterCard

Expiry (dd/mm/yyyy):      

CVC Code:      

Credit card number:      

Direct Monetary Transfer

Note that a 7 EUR bank fee has to be added to the membership fee and paid. The
membership application is not valid unless the correct amount is transferred.

Membership fee       €

+ Bank transfer fee 7 €

Total cost to be transferred:       €