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Note: This form cannot be sent over the Internet. It should be filled out, printed, and then sent by mail or fax to the address below.
Please check HERE to determine the correct category for your membership
Name of Association:
Postal Address:
City:
Province/State:
Country:
Postal Code:
Phone:
Fax:
E-mail:
Web Site:
Name of Contact Person: Mr/Ms
Name of Highest Official: Mr/Ms
Position title:
Charge to the value of: EUR
Card Number:
CVC II/Security Code: (See back of your credit card, the last three digits)
Expiration Date (mm/yyyy):
Card is in the name of:
Signature :____________________ Date:____________