ETN application forms

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PfeilGeneral information on the membership application

Institutions : Euro 111

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(Please complete this application form)

* obligatory

 Name of the institution *

 Department and/or section

 Name of the institution (in English)

 Department and/or section (in English)

 Street, no. (resp. bldg./quarter) *

 Cntr. *

 Post C. *

 City (resp. region/district/province)*

 Phone (general)

 Fax (general)

 E-mail (general)

 Internet homepage
Yes No
Link exchange

 Contact person  Second contact person
 (if nessesary)

 First name, surname *

 First name, surname

 Function *


 Phone (direct)

 Phone (direct)

 E-mail (personal)

Mode of Payment

  I will pay after receipt of your confirmation/invoice...

...to your account with CAIXABANK, IBAN: ES37 2100 3651 4222 0016 2818, BIC/SWIFT: CAIXESBBXXX (in the Euro zone only!).