<% '''''''''''''''''''''''''''''''''''''''''''''''''''''''''' '' Copyright 2002-2004 by Robert Aung. '' '' All rights reserved. No part of this work may be '' reproduced, stored, or transmitted in any form, '' without prior written permission. '' '' Neither this page, nor any part of it, may be '' modified, copied, distributed, displayed, reproduced, '' published, licensed, sold, placed on a web site, '' or used to create derivitive works without the '' express written consent of the author. Any use '' of this page is subject to the terms of a license '' agreement with the author. '' '' To obtain a license for this software, contact the '' author at robert.aung@verizon.net. '''''''''''''''''''''''''''''''''''''''''''''''''''''''''' %> iNEER - International Network for Engineering Education & Research

iNEER Online Payment Page

Information about Person Making Payment

First Name: Last Name:
Email: Phone:

Information as it Appears on Credit Card (if credit card is used)

First Name: Last Name:
City: State:
Zip: Country:
Phone: Fax:

Payment Information

Name of Person for Whom Payment is being Made:
Reason for Payment (e.g. "Registration, 2005 book, etc."):
Amount to be paid in US$:

Payment Type (please check appropriate box and click "Submit"; see instructions on following page):

 Online Credit Card (MasterCard and Visa) 
 Check (must be from a U.S. bank) 
 Wire Transfer