

1 I agree to be bound by the Memorandum and Articles of Association and the Byelaws of the Society, as amended from time to
time.
2. Data Protection Act 1998. I understand that information provided by me on this form willbe processed by the ESCV
secretariat and willbe used for the purpose of:
(i) providing me with the benefits of membership and goods and services ordered, and for billing and subscription renewal
(ii) listing my name, professional address and, if provided, my telephone/fax numbers and email address on the secure members
pages of the ESCV website, unless I have indicated otherwise below
(iii) providing me with email alerts about Society activities, unless I have indicated otherwise below.
If you do not wish your details to be included on the Society website, please tick here
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If you do not wish to receive email alerts about Society activities, please tick here
Signature
Date
5. Payment
Payment willbe accepted only in Euros (€)
Please transfer your membership fee to:
ESCV, Hanzeplein 1, P.O. Box 30.001, Groningen, The Netherlands
ABN AMRO bank Groningen
IBAN Bank account:
NL44ABNA0506972402
BIC number :
ABNANL2A
Send completed form, together with remittance, to
:
Mrs. C.B.M.B. Jager
Assistant of Dr. S.A. Nordbö,
Treasurer of the ESCV
University Medical Center Groningen
The University of Groningen
Department of Medical Microbiology
Division of Clinical Virology
De Brug, Room 40.2.040
HPC EB80
P.O. Box 30.001
9700 RB
Hanzeplein 1
9713 GZ
Groningen, The Netherlands
Tel: +31-50-361.0223Fax:
+31-50-361.9105
E-mail:
c.b.m.b.jager@umcg.nlEuropean Society for Clinical Virology
Registered charity no. 1099537
A company limited by guarantee
Registered in England no. 4620455
Registered office as above