EFN - FORMUL┐ě REGISTRACE ĂLENA

Aby jste se stali ˙leny EFN,
VYPL¤TE, VYTISKNÝTE, PODEPI÷TE a potom za÷lete tento formul÷Ť registrace va÷eho ˙lenstvÝ na n÷sledujÝcÝ adresu:

Environmentalists For Nuclear Energy
55 rue Victor Hugo, 78800 Houilles, France
Telefon: +33 1 30 86 00 33 - Fax: +33 1 30 86 00 10 ; E-mail: cz[at]ecolo.org (spam prevention: replace [at] by @)

Pě═JMEN═*:

JM¸NO*:

ADRESA*:

PSĂ*:

OBEC*:

COUNTRY*:

OBEC*:

TELEFON:

FAX :

PROFESE :

VÝK:

years


(*) Required zone
 


Registrujte, prosÝm moje ˙lenstvÝ v n÷sledujÝcÝ kategorii:

Supporting Member : I approve your action (FREE - send to EFN by fax)

SympatizujÝcÝ ˙len : 25 Euros (or 25 US$)
AktivnÝ ˙len : 50 Euros (or 50 US$)
SponzorujÝcÝ ˙len :
100 Euros (or 100 US$)

Dues-paying members will receive a receipt by traditional mail. New members are subject to acceptation by the Board of Directors of EFN. You will be informed by the e-mailing list of EFN.

YES, I agree to be a local correspondent of EFN in the following area :
Dodate˙n┐ dar pro podporu Institute : Euros

Celkov÷ darovan÷ ˙÷stka: Euros or US$
placeno : credit card
÷ekem pŤevodem
na ˙˙et: "Environmentalists For Nuclear Energy"

 

Datum :    Podpis :  

 

FIRST STEP : fill out, print and send this page to EFN

After completing this form, select your printer (or PDF format) and click on the "Print" button to print this page. You can also use the "Print" button in the menu of your navigating software. 

This page can be printed either : 1/ on paper, in this case, fax the paper-printed form to +33 1 30 86 00 10 or 2/ to a PDF file (using ACROBAT WRITER or a similar software), in this case send the PDF file to cz[at]ecolo.org

Sign the printed paper version if you print this page on paper and send it to EFN by fax, or type your name or any alpha-numerical code legally representing your signature, for example : /Peter Smith/ or /psmith8492xfp8902/ into the "signature" zone, if this page is printed to a PDF file and sent to EFN by e-mail.

 

SECOND STEP : send your payment to EFN by one of the three following methods

Payment by credit card (in Euros): click on the visa card logo below (choose your currency), and follow the instructions. Most credit cards are accepted (Visa, Mastercard, American Express...). The amount of your payment will be debited from your credit card account. Do not send your credit card number by fax to EFN, please make the payment yourself as indicated by clicking on the visa card icon below. The transmission of your credit card number is securized by https protocol.

click here: for payment by credit card in Euros (EUR)

Payment by wire transfer (in Euros): send an e-mail to cz[at]ecolo.org (spam prevention: replace [at] by @)asking for instructions concerning payment by electronic wire transfer. You will receive instructions by e-mail.

Payment by cheque (in Euros): send this membership registration form printed on paper by traditional mail with your cheque to : Environmentalists For Nuclear Energy, 55 rue Victor Hugo, 78800 Houilles, France. Cheques are to be denominated in EUROS and to be drawn on a French bank. If your bank is not in France, ask your banker to prepare a cheque drawn on a French bank. Eurocheques are not accepted.

According to the law, you have the right to access and correct the computerized information which concerns you.