FOUNDATION FOR INTELLIGENT PHYSICAL AGENTS

c/o Law Offices of Me. Joelle Knopfel
7 place de la Fusterie
PO Box 3362
1211 Geneva 3
SWITZERLAND

Pro-forma invoice

Company/Organisation

 

 

Contact Name

 

 

Telephone/Fax/E-mail

 

 

Address

 

 

 

 

 

Headquarters City

 

 

Date

 

 

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

 

[  ]  2,250

 

 

[  ]  1,688

 

 

[  ]  1,125

 

 

[  ]  563

 

,

USD

 

[  ]  1,800

 

 

[  ]  1,350

 

 

[  ]  900

 

 

[  ]    450

 

 

EURO

 

[  ]  1,500

 

 

[  ]  1,125

 

 

[  ]  750

 

 

[  ]    375

 

 

 

 

 

 

 

 

 

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

Send payment to:

SG Private Banking SA 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
135 Maitland Drive
Alameda, CA 94502 USA
Telephone: +1 510 337 0693
Facsimilie: +1 510 337 0693
Email: secretariat@fipa.org