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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

͘

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: +31-50-361.0223

Fax:

+31-50-361.9105

E-mail:

c.b.m.b.jager@umcg.nl

European Society for Clinical Virology

Registered charity no. 1099537

A company limited by guarantee

Registered in England no. 4620455

Registered office as above