application.htm

EUROPEAN

ASSOCIATION OF

FISH PATHOLOGISTS

MEMBERSHIP APPLICATION FORM

Name:
Address/Organisation:

Qualifications:

Please mark the category of membership for which you are applying:
Regular (CHF 60)
Student (CHF 30)
Sustaining (CHF 400)
Library subscription (CHF 100)

Signature: Date:

Please markyour research interests:

A Fish Diseases	G Immunology	M Nutrition
S Teaching	B Shellfish Diseases	H Diagnostics
N Genetics	T Marine Pathology	C Bacteriology
I Treatments	O Pathognenesis	V Ornamentals
D Virology	J Chemotherapy	P Legislation
E Mycology	K Histopathology	Q Pathophysiology
F Parasitology	L Pollution	R Endocrinology

PAYMENT

CREDIT CARD PAYMENT:
Please charge my credit card the following amount:

______________________________

Mastercard Visa American Express Diners Club

Card number: ____________________
Expiry date: ____________________

BANK TRANSFER: (A or B option)
A: I enclose a copy of bank transfer payment to my EAFP Branch Official
B: I enclose a copy of bank transfer payment to:

EAFP, c/o P.J. Midtlyng
VESO PO Box 8109 De
N-0032 Oslo
Norway

Account no 0825-0309237 (Postbank International, N-0021 Oslo) or
Account no 1607-8746169 (Union Bank of Norway, PO Box 1172 Sentrum, N-0107 Oslo)

___________ ___________ ___________________
Place Date Signature

Please return this form to your Branch Official, or in their absence, directly to the General Secretary:

Dr. David Bruno
EAFP General Secretary
Marine Laboratory
Victoria Road
Aberdeen AB11 9DB
Scotland