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1 forms found in the DOM

Name: billing — POST action.php

<form name="billing" action="action.php" onsubmit="return validateForm()" method="post">
  <table class="plain">
    <tbody>
      <tr>
        <td colspan="2" align="center" style="font-size: 15pt; font-weight: bold;">Contact &amp; Billing Information<br>
          <span style="font-size: 12">Required fields marked with </span><span class="required-field">*</span>
        </td>
      </tr>
      <tr>
        <td><b>Title:</b></td>
        <td><input type="text" name="title" size="20" maxlength="20"></td>
      </tr>
      <tr>
        <td><b>First name:</b></td>
        <td><input type="text" name="first_name" size="25" maxlength="25"><span class="required-field">*</span></td>
      </tr>
      <tr>
        <td><b>Middle initial:</b></td>
        <td><input type="text" name="middle_initial" size="5" maxlength="5"></td>
      </tr>
      <tr>
        <td><b>Last name:</b></td>
        <td><input type="text" name="last_name" size="40" maxlength="40"><span class="required-field">*</span></td>
      </tr>
      <tr>
        <td><b>Address (Line 1):</b></td>
        <td><input type="text" name="bill_address1" size="50" maxlength="100"><span class="required-field">*</span></td>
      </tr>
      <tr>
        <td><b>Address (Line 2):</b></td>
        <td><input type="text" name="bill_address2" size="50" maxlength="100"></td>
      </tr>
      <tr>
        <td><b>Address (Line 3):</b></td>
        <td><input type="text" name="bill_address3" size="50" maxlength="100"></td>
      </tr>
      <tr>
        <td><b>Address (Line 4):</b></td>
        <td><input type="text" name="bill_address4" size="50" maxlength="100"></td>
      </tr>
      <tr>
        <td><b>City:</b></td>
        <td><input type="text" name="bill_city" size="50" maxlength="50"><span class="required-field">*</span></td>
      </tr>
      <tr>
        <td><b>State/Province:</b></td>
        <td><input type="text" name="bill_state" size="50" maxlength="50"></td>
      </tr>
      <tr>
        <td><b>Postal code:</b></td>
        <td><input type="text" name="bill_postal_code" size="20" maxlength="20"></td>
      </tr>
      <tr>
        <td><b>Country:</b></td>
        <td><input type="text" name="bill_country" size="30" maxlength="30"><span class="required-field">*</span></td>
      </tr>
      <tr>
        <td><b>Affiliation  or occupation:</b></td>
        <td><input type="text" name="institution_name" size="50" maxlength="100"></td>
      </tr>
      <tr>
        <td><b>E-mail address:</b></td>
        <td><input type="text" name="email" size="50" maxlength="100"><span class="required-field">*</span></td>
      </tr>
      <tr>
        <td colspan="2" align="center" style="font-size: 15pt; font-weight: bold;">Shipping Information (if different)</td>
      </tr>
      <tr>
        <td><b>Shipping Name:</b></td>
        <td><input type="text" name="ship_name" size="50" maxlength="100"></td>
      </tr>
      <tr>
        <td><b>Address (Line 1):</b></td>
        <td><input type="text" name="ship_address1" size="50" maxlength="100"></td>
      </tr>
      <tr>
        <td><b>Address (Line 2):</b></td>
        <td><input type="text" name="ship_address2" size="50" maxlength="100"></td>
      </tr>
      <tr>
        <td><b>Address (Line 3):</b></td>
        <td><input type="text" name="ship_address3" size="50" maxlength="100"></td>
      </tr>
      <tr>
        <td><b>Address (Line 4):</b></td>
        <td><input type="text" name="ship_address4" size="50" maxlength="100"></td>
      </tr>
      <tr>
        <td><b>City:</b></td>
        <td><input type="text" name="ship_city" size="50" maxlength="50"></td>
      </tr>
      <tr>
        <td><b>State/Province:</b></td>
        <td><input type="text" name="ship_state" size="50" maxlength="50"></td>
      </tr>
      <tr>
        <td><b>Postal code:</b></td>
        <td><input type="text" name="ship_postal_code" size="20" maxlength="20"></td>
      </tr>
      <tr>
        <td><b>Country:</b></td>
        <td><input type="text" name="ship_country" size="30" maxlength="30"></td>
      </tr>
    </tbody>
  </table>
  <br>
  <h3 align="center">Select A Payment Type</h3>
  <table>
    <tbody>
      <tr>
        <td valign="top" style="background: white; color: black;">
          <input type="radio" name="payment_method" value="paypal">
        </td>
        <td valign="top" style="background: white; color: black;">
          <img src="images/cc.jpg" width="125" align="center" border="0"> Credit card payment online <p class="boxed-area"><b>NOTE:</b><br>Our credit and debit card transactions are handled online by <a href="http://www.paypal.com">PayPal</a>. The
            PayPal site accepts Visa, Mastercard, American Express, and Discover cards for payments in either U.S. dollars or Euros. Transactions are processed securely in accordance with banking industry standards. You do not need to be a PayPal
            account holder to use this service. When you choose to pay directly with a card, PayPal charges the IBS a small fee, but your money is not routed through their banking system. </p>
        </td>
      </tr>
      <!--
<tr><td style="background: white; color: black;">
<input type="radio" name="payment_method" value="euro">
</td><td style="background: white; color: black;">
Direct deposit in Euros to the IBS account with Deutsche Bank</a>
</td></tr>
-->
      <tr>
        <td style="background: white; color: black;">
          <input type="radio" name="payment_method" value="check">
        </td>
        <td style="background: white; color: black;"> Payment by check in U.S. dollars via postal mail </td>
      </tr>
    </tbody>
  </table>
  <br>
  <input type="submit" name="info_form" value="Continue">
  <button type="reset" value="Clear form">Clear Form</button>
</form>

Text Content

IBS MEMBERSHIP

--------------------------------------------------------------------------------

All IBS members receive The Brecht Yearbook and Communications from the
International Brecht Society as a benefit of membership and are invited to
participate in the Society's symposia. The Society is officially multi-lingual;
Communications welcomes contributions in English, German, Spanish, and French.


IBS DUES

Membership Type Dues US $ Dues € Regular member / Ordentliches Mitglied: $ 60.00
€ 60.00 Sustaining member / Fördermitglied $ 70.00 € 70.00 Student or retired
member / Student oder emeritiertes Mitglied $  40.00 € 40.00 Lifetime (retirees
only) / Lebenslang (nur Pensionierte) $ 500.00 € 450.00 Institutional member /
Korporatives Mitglied $ 75.00 € 75.00



TELL US WHO YOU ARE

Contact & Billing Information
Required fields marked with * Title: First name: * Middle initial: Last name: *
Address (Line 1): * Address (Line 2): Address (Line 3): Address (Line 4): City:
* State/Province: Postal code: Country: * Affiliation or occupation: E-mail
address: * Shipping Information (if different) Shipping Name: Address (Line 1):
Address (Line 2): Address (Line 3): Address (Line 4): City: State/Province:
Postal code: Country:



SELECT A PAYMENT TYPE

Credit card payment online

NOTE:
Our credit and debit card transactions are handled online by PayPal. The PayPal
site accepts Visa, Mastercard, American Express, and Discover cards for payments
in either U.S. dollars or Euros. Transactions are processed securely in
accordance with banking industry standards. You do not need to be a PayPal
account holder to use this service. When you choose to pay directly with a card,
PayPal charges the IBS a small fee, but your money is not routed through their
banking system.

Payment by check in U.S. dollars via postal mail


Clear Form


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