EATCS Membership Application

Name:
 
First name:
 
Email:
 
Mailing Address:
 
 
 
 
Date:
Signature:
 
Membership fee:
How many years of membership:

DM 45.- (or US$ 33.-) one year membership
DM 24.- (or US$ 18.-) air mail delivery of the EATCS Bulletin

Method of payment

[  ] Please charge my credit card:

(  ) Eurocard/Mastercard (  ) Visa

Card number:
Expiration date:
Address: (when different from mailing address above)
 
 
Signature:

 

[  ] Check Enclosed

[  ] Transferred to EATCS account

add DM 8.-- (or US$ 6.-) to cover the bank charges

Generale Bank Antwerpen
Antwerp (Wilrijk), Belgium
Account number: 220-0596350-30-01130

[  ] Cash Enclosed

Prof.Dr. D. Janssens
University of Antwerp (UIA),
Dept. of Mathematics and Computer Science
Universiteitsplein, 1
B-2610 Wilrijk, Belgium

Fax: (+32) 3 820 2421