THE ATHENIAN POLICY FORUM INC
NEW APPLICATION ÿ RENEWAL ÿ LIFE FELLOWSHIP ÿ
(Please print a copy of the application form, fill out and mail, together with fees, to the address below)
Name to Appear on Certificate: _______________________________________________________________________
First and Last Name (print)
Exact Position Title: _______________________________________________________________________________
Complete Mailing Address:
_________________________________________________________________________
_________________________________________________________________________
(Make sure you include dept./institution, street & number, city, country, zip/postal code)
Telephone Number: _______________________________________________________________________________
(including area/country code)
FAX Number (including area/country code): _____________________________________________________________
E Mail: _________________________________________________________________________________________
Title of Project:
___________________________________________________________________________________
___________________________________________________________________________________
Application fee: There is an APPLICATION FEE of $95.00 US. to defray administrative costs.
Please send either a check (drawn on a US bank), or money order, payable to the Athenian Policy
Forum, ALTERNATIVELY you may have your bank WIRE the funds to the credit of the
Athenian Policy Forum account. Here are the details:
Account No. 38512 001 450 3580 US Dollar account
Bank Address: Bank of Montreal
York Lanes, York University
4700 Keele Street
Toronto, Ont., M3J 1P3, Canada
(416) 665-4775
The cost for a LIFE FELLOWSHIP is $ 495.00 US
PLEASE RETURN THIS APPLICATION FORM WITH A BRIEF ABSTRACT OF THE
PROJECT, AND THE APPLICATION FEE TO:
| Secretariat The Athenian Policy Forum 51 Havenbrook Blvd. Toronto, Ontario M2J 1A7 Canada |
Phone: (416) 736-2100 ext.
66692 Fax: (416) 498-1285 E-mail: chrisp@yorku.ca |