Name:

Title:

Organization:

Nationality:

Address:

Country:

Phone:

Fax:

e-Mail Address:

Year of Birth:

Education:

B.S.
M.S.
Ph.D.

Education (Others):

Type of Organization:

Government
NGO
University
Private Sector
Farmer/Producer's organization

Type of Organization(Others):

Interest on Rice:

Science
Economics and Trade
Public Awareness
Education
Grain Quality
Eco-tourism
Cultural Heritage
Value-added products
Nutrition

Interest on Rice(Others):

Comments:

Lifetime Membership fees: US$100

Please mail or e-mail the completed application form back to us. You can send payment of one time contribution of US$100 either by:

Sending to ARF a cross check for an amount of US$100.00, or equivalent amount in pesos, made payable to the Asia Rice Foundation; or
Issuing a bank transfer of fund to the account of the Asia Rice Foundation, in either US dollars or Philippine pesos, to ARF’s dollar savings account number 0976000994 or peso savings account number 76900434, with Planters Development Bank, UP Los Baños Branch, UPLB Campus, College, Laguna 4031, Philippines. Please present the ‘Single Customer Credit Transfer Incoming Remittance Guide’ (below) to your bank to facilitate the fund transfer.

arf College, Laguna 4031, Philippines Tel/Fax: +63 49 536-2285 E-mail: asia_rice@agri.searca.org www.asiarice.org

SINGLE CUSTOMER CREDIT TRANSFER INCOMING REMITTANCE GUIDE
PLEASE REMIT TO: WELLS FARGO BANK, N.A.
Intermediary Bank (Planstersbank Correspondent Bank)
	Bank Name:	Wells Fargo Bank, N.A. FKA Wachovia Bank
	Swift ID:	PNBPUS3NNYC
	Routing No.:	026005092
Beneficiary Bank
	USD Account No.:	2000191121171
	Bank Name:	Planters Development Bank Makati City , Philippines
Beneficiary Customer details:
	Account Number:	0976000994
	Account Name:	THE ASIA RICE FOUNDATION, INC.
	Address & Tel. No.:	SEARCA Main Building COLLEGE, LAGUNA 4031, Philippines 049-536-2285
Sender to Receiver Info: Acct with UPLB Branch

Before submitting the form, please take note of the abovestated important information.