Membership Form
Membership 2014
□ €15.00 / $20 / £13 Student
□ €30.00 / $40 / £26 General
Membership 2014 + 2015
□ €25.00 / $34 / £21 Student
□ €50.00 / $68 / £42 General
Personal Information
Name:
Address:
Country:
Postal Code:
Affiliation:
E-mail Address:
Form of Payment: Please e-mail the completed form to <[email protected]> or send to Peter de Voogd, Stadhouderslaan 72, 3583 JL Utrecht, Netherlands.
either via Paypal to <[email protected]>
or (euro zone only) by bank transfer to ING Bank, acct. of St. Int. Sterne Foundation, 6252439, IBAN: NL92INGB0006252439, Bic/swift: INGBNL2A.