IUBMB Best Poster Prize Award

Bank form – Best Poster

Name of awardee

As spelled on application form

Name of Best Poster Prize in IUBMB Journal

Total Prize Award

$USD

Enter approved amount

Name of Meeting Attended

Location

Number of days meeting attended

Start Date

End Date

First Name

Middle Name

Last Name

Full Mailing Address

Street address, City, Province, ZIP/Postal code, Country

Phone

Name of Account Holder

As spelled on the bank documents

Bank Name

Bank Address

City and State only

Account number

*IBAN format for non-US banks; *Canadian bank format is branch transit-financial institution-account number

SWIFT / BANK / BIC CODE

ABA Code / Routing Number (US)

nine-digit string

*You will need to provide the full mailing address of the branch where the account is if you do not have any of the codes

Address

*I verified that the provided account details are accurate and can receive bank transfers from abroad and in USD (checkmark if you confirm)

I CONFIRM

If you are human, leave this field blank.