Credit Card Payment Form

 After you have submitted your abstract for review, complete the following form and fax it to the Society at 203-323-7485 in Stamford, Connecticut. We can only accept Visa or Mastercard. Submit one of these forms for each abstract you submit. Your abstract cannot be fully processed until the payment is received, and no abstracts will be accepted after December 11, 1998. The fee is $45 US for each abstract. 

  -Credit Card Type

  -Credit Card Number

  -Expiration Date

  -Name of Cardholder

Complete and Exact Title of Your Abstract: