CONTACT

To become an ESVCN member, please fill out this form and click 'send'.

Name:
Institute:
Address:
Telephone:
Fax:
E-mail:

The ESVCN membership's fee, including contribution to ECVIM, is 40 euro for 1 year, 72 euro for 2 years, and 96 euros for 3 years

40 euro

72 euro

96 euro

Payment: the treasurer will contact you when receiving the completed form.

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Dr Jacques DEBRAEKELEER, treasurer of the ESVCN
Strijdersstraat, 5
B-3300 Tienen
Belgium
Tel. home +32 16820225
Tel. work +32 26749222
Mobile +32 476850320
Fax +32 26749210
E-mail : jaak_erna@skynet.be