Subscription Form for NEW PERSONAL MEMBERS

Please fill out this electronic form if you wish to become a member of SUERF, including payment details.

Title:

Name:

Position held:

Department:

Institution:

Address:

City:

ZIP:

Country:

Telephone:

Fax:

Email:

Payment: The annual subscription fee of EUR 50 will be paid into the SUERF account.
Iban code: BE29 439-7946987-64,
Swift code: KREDBEBB,
KBC Bank N.V., Arenbergstraat 11, 1000 Brussels, Belgium.

I wish the annual subscription fee of EUR 50 to be charged to my credit card (details below)

Type of Creditcard:

Creditcard number:

Expiry date (MM/YY):

Name of Cardholder:

<<< Back