Membership Registration & Payment Form
Please tick appropriate membership:
I apply for a
student / private membership
:
Please select:
1 year: EUR 48
3 years (2011-2013): EUR 80
I apply for a
professional membership
:
Please select:
1 year: EUR 65
3 years (2011-2013): EUR 120
My organisation applies for an
NGO membership
:
Please select:
1 year: EUR 65
3 years (2011-2013): EUR 120
My organisation applies for an
organisation membership
:
Please select:
1 year: EUR 300
3 years (2011-2013): EUR 500
Yes, we would like to receive an extra copy of Coastal & Marine (formerly Coastline magazine) at EUR 15 extra per year.
Name:
Organisation:
Address:
Town:
Country:
Tel:
Fax:
E-mail:
Payment
Please transfer membership fees to:
Account holder:
EUCC in Leiden, Netherlands
IBAN:
NL 67 INGB 0003 1564 55
SWIFT/BIC:
INGBNL2A
Bank name:
ING
IMPORTANT!
Specify "DANCORE fee", your name and type of membership on the transfer.