EFN - Membership registration form

Click here to download EFN's membership registration form in PDF format to be photocopied and distributed to your friends, colleagues, neighbors and relatives

To become a member of the Association of Environmentalists For Nuclear Energy
FILL OUT, PRINT (to paper or PDF file) and RETURN this registration form to :

Environmentalists For Nuclear Energy
Fax: +33 9 55 29 00 22 ; E-mail: en[at]ecolo.org (spam prevention: replace [at] by @)

First name* :

Name* :

Address* :

Zip code* :

City* :

Country* :

E-mail* :

Phone :

Fax :

Profession :

Age :

years

(*) Required zone  

 

Please register or update my membership in the following category:

Supporting Member: I approve your action (FREE - send by fax or PDF file)
Sympathizing Member: 25 Euros for one year
Active Member:  50 Euros for one year
Donating Member: 100 Euros for one year.

Dues-paying members will receive a receipt. You will be informed by e-mail.
New members are admitted subject to the approval of the Board of Directors.

I agree to be a local correspondent of EFN in my area :
Additional donation to support EFN : Euros

Total amount: Euros
paid by : credit card bank to bank transfer cheque
to the order of: "Environmentalists For Nuclear Energy"

 

 

 

Date :    Signature:  

To sign, you can sign the printed paper version if you print this page on paper (in this case please send it by fax or mail), or please type into the"signature" zone your name or any alpha-numerical code legally representing your signature, for example : /John Smith/ or /jsmith8492xfp8902/ if this page is transmitted electronically.

 

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

This page should be printed and sent by e-mail as a PDF file or by fax to +33 9 55 29 00 22 (if you pay by credit card or electronic wire transfer) or by postal mail (with the cheque, if you pay by cheque). By clicking on the "PRINT" button, you will print this page. You can also use the "Print" button in the menu of your navigating software.

 

 

 

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

Payment by credit card (in Euros): note the amount to be paid, then click on the visa card logo below (choose your currency), type the amount of your membership in the appropriate box and follow the instructions. Most credit cards are accepted (Visa, Mastercard, American Express...). The transmission of your credit card number is securized by https protocol.

click : for payment by credit card

 

 

Payment by bank to bank transfer (in Euros): send this membership registration form to EFN by fax or e-mail, and send an e-mail to en[at]ecolo.org (spam prevention: replace [at] by @) asking for instructions concerning payment by bank to bank transfer. You will receive instructions by e-mail.

Payment by cheque (in Euros): send this membership registration form to EFN 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.