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Society for Psychosomatic Medicine
lid worden:
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Voornaam
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Familienaam
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Discipline
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arts, psycholoog, kinesitherapeut, maatschappelijk werker, etc
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contactgegevens
Straat
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Huisnummer
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Postcode
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Gemeente
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Land
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België
Nederland
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E-mail
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e-mail adres waarnaar de bevestiging verzonden kan worden.
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Ik word lid van de Society
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jaarbijdrage voor 2020:
€ 35
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Memo
Noteer hier eventuele opmerkingen
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Betalen kan op rekening NL29ABNA0975258699 met vermelding "lid 2020 - familienaam"
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