VVE – Application form
In compliance with the privacy law, please indicate whether your data (name, address, phone- and mobile-number, e-mail and special interest) may be published in the Newsletter or not.
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.
Name *
First name(s) *
Date of birth *
Will never be published in the Newsletter.
Street and number *
ZIP-code *
Town *
Country *
Phone-number
Mobile-number
Field of Interest *
Additional remark(s)
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 *
Required
The following data may be published in the Newsletter: *
yes
no
Name
Address
E-mail address
Phone-number
Mobile-number
Special interest
A copy of your responses will be emailed to the address you provided.
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