American Nutritional Medical Association Inc.
P.O.Box 66005 Stockton, CA 95206 U.S.A.
We would prefer type written form for neat entries and would request you to avoid sending hand written forms.
APPLICANT DETAILS (Please fill in BLOCK letters)
First Name _______________________________________________________________
Last Name _______________________________________________________________
Institution / Organization ____________________________________________________
Zip Code ________________________________________________________________
Telephone* with STD code _________________________________________________
Category GENERAL LICENSIATE ASSOCIATE
Members USD 200 USD 300 USD 200
Students USD 200
Life Members USD 1000 USD 1500 USD 1000
Renewals USD 250 USD 250 USD 150
Executive Member USD 2000 USD 2000 USD 1500
Registration form, completed in all respect along with the registration fee, may be sent to the ANMA secretariat by any of the options below,
1. You can transfer the amount by Wire/Swift transfer in the ANMA Bank account:
• Bank Name: Bank of America
• Accounts name: ANMA
• Account No: 11394-44401
2.Payment could also be made by DD/ Multi-city Cheques/Bank transfer to your nearest IHMS
authorised Center. A list of authorised centers may be obtained upon request http://anmainc.webnode.com/contact-us/
Please pay the fee through demand draft/credit card.
Membership would be confirmed subjected to realization of cheque.
• For students, a certificate from the head of department / Institution is compulsory.
• The fee of Executive Members includes Life membership of ANMA.