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VVE – Application form
In compliance with the privacy law, please indicate whether your data (name, address, phone-number, e-mail and special interest) may be published in the Newsletter or not.
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Email
*
Your email
I hereby apply to become a member starting in the year:
*
If you opt to become a member starting from the current year, we will send you all the volumes of our Journal PHEGEA already published this year.
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Name
*
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First name(s)
*
Your answer
Date of birth
*
Will never be published in the Newsletter.
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Street and number
*
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ZIP-code
*
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Town
*
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Country
*
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Phone-number
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I want to receive the journal
Phegea
as
*
a printed copy
digitally as a pdf
Field of Interest
*
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Additional remark(s)
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I accept the statutes of the society and I am prepared to pay the yearly membership fee. The statutes of the society can be found on the website:
http://www.phegea.org/Root/Reglementen.htm
*
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Special interest
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