Subscription

Membership subscription ABPP-BPSG

Date

New subscriber
Renewal

Former membership N° (if known)

Region

Membership N°:

Application for Year

All fee payable in Euro - Please tick the appropriate box :

New member	Eur 50,00
Annual dues	Eur 58,00
Overseas dues	Eur 60,00

Name :

First name:

Address :

Postcode :

Country :

Tel N° :

Fax N° :

E-mail :

Payment by bank account to ABPP-BPSG Delta Lloyd Belgium N° 635.2612001.36
By euro-cheques or post cheques
13, place Bosch
B-1300 Wavre
IBAN BE 46 635 2612001-36
Swift code BNAGBE-BB

Our magazine "Kaolin" is published each three month and is sent to all members.

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