HOMEIMPRINTDISCLAIMERCONTACTSITEMAPPRINT  

EBSA Events


15th Annual Conference of the European Biosafety Association

Manchester/UK

Application form for EBSA membership


    Mr
    Mrs/Ms
    First Name
    Family Name
    Academic Title
    Company/University
    Department/Institute
    Street, No or P.O.Box
    Postal Code
    City
    Country
    Phone
    Fax
    Email
    URL


    If your invoice should be sent to a special invoicing/billing address, please insert this address here:



    I shall pay the total amount:
    by bank transfer after receipt of invoice
    by credit card

    After handling of your registration you will receive an invoice by postal mail.

    If you choose to pay by credit card, please enter your credit card information below
    (Secure data transmission over SSL)
    American Express
    VISA
    MasterCard
    Credit card number
    Expiry date (MM-YYYY)
    Card Verification Value/Code 2 (CVV2/CVC2)
    These are 3 digits (AmEx: 4 digits) in the sign field on the back side of your credit card at the end of the card number (AmEx: in front of your credit card above the card number).

    If the VAT number of your company or purchase order number should be mentioned in the invoice, please insert it here:
    VAT number (corresponding to the billing address)
    Purchase order number


    Membership Information
    The membership fee is valid for the current calendar year (Jan 1 - Dec 31) and is renewable on Jan 1st of each following year. In case you chose the "4 years membership" your membership will be renewed automatically during this period
    EBSA Individual Member EUR
    EBSA & BBP Individual Member EUR
    EBSA Corporate Member EUR
    EBSA Individual Member 4 years (2012-2015) EUR
    EBSA & BBP Individual Member 4 years (2012-2015) EUR