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EAHIL
membership application form for colleagues OUTSIDE EUROPE
INDIVIDUAL
MEMBERSHIP APPLICATION at annual fee of: EUR 50 (2009)
Family name: ……………………………………………………………………………
First name: ……...………………………………………………………………………
Institutional address
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Institute/Company:
…………………………………………………………………………………
Address:
…...…………………………………………………………………………….…
City code: ………………………………… City:…………………………… …………
Country: ...………………………… ………………………………………………………
Telephone …………...………………………………………………………………………
Fax: ……………………………………………..………………………………………………
E-mail: …...……………………………………………………………………………………
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Home address
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Home address:
……….….…………………………………………………………………
City code: ………………………… ……………City:
……………………………………
Country: ………………………………………………………………………….….…………
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Do you want to join the EAHIL-L
discussion list?
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( ) yes
( ) no
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Do you want to receive a
print version of the Journal of EAHIL?
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( ) yes
( ) no
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At which address do you prefer
to receive the Journal of EAHIL?
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( ) Company address
( ) Home address
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At which address do you prefer
to receive the membership invoices?
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( ) Company address
( ) Home address
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( ) I
do not need to receive an invoice; an e-mail message confirming receipt
of payment will do.
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( ) I will
use the card payment form properly filled in with all details and
undersigned, which will reach you by fax, e-mail or mail within 14
days.
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Membership in other associations?:
…………………..…………………………..………
See statutes for definition of
membership
Signature:
……………………………………………………………………..
Position:
……………………………………………………………………....
Date:
…………………………………………………………………………....
Send the membership application form to:
EAHIL Secretariat, P.O. Box 1393, 3600
BJ Maarssen
The Netherlands, fax + 31 346 550966,
e-mail: EAHIL at nic.surfnet.nl
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