HISTORIA MATEMATICA [HM] Membership Application

Please, mind that you may enter "N/A" in most of those fields which do not apply to your circumstances. However, all fields marked * are required.
Full Name
* First Name
Middle Name
* Last Name
* Country
* Class membership		Help
Personal information    (Uncheck the fields you do not wish to make publicly available)
	* Place of birth	(City, Country)
	* Date of birth	(e.g. December 12, 1959)
	* Profession
	* Field Interest	If not specified, type it in the "Further info" field below.
	Further info
	* Institution
	* Postal address
	* Email 1	(Our listserv is set up to reject webmail addresses)
	Email 2
	Phone (Office)
	Phone (Home)
	FAX
	URL
Security
Whereas the password below will prevent others from changing your entry, it will allow you to update your own information.
* Password
* Confirm Password