FORMUL¿Ø REGISTRACE ÆLENA IBC


Aby jste se stali úleny "Institut Bruno Comby",
VYPLÏTE, VYTISKNíTE, PODEPIöTE a potom zaölete tento formulö› registrace vaöeho úlenství na nösledující adresu:

Institut Bruno Comby
55 rue Victor Hugo, 78800 Houilles, France
Telefon: +33 1 30 86 00 33 - Fax: +33 9 55 29 00 22; E-mail: ibc-cz[at]comby.org (spam prevention: replace [at] by @ in the e-mail)

PØÍJMENÍ*:

JM÷NO*:

ADRESA*:

PSÆ*:

OBEC*:

COUNTRY*:

OBEC*:

TELEFON:

FAX :

PROFESE:

VíK:

years


(*) Required zone 


Registrujte, prosím moje úlenství v nösledující kategorii:

Supporting Member: I approve your action (FREE - send to IBC by fax)

Sympatizující úlen: 25 Euros
Aktivní úlen: 50 Euros
Sponzorující úlen: 100 Euros

Dues-paying members will receive a receipt by traditional mail. New members are subject to acceptation by the Board of Directors of IBC. You will be informed by the e-mailing list of IBC.

YES, I agree to be a local correspondent of IBC in the following area :
Dodateún¿ dar pro podporu Institute : Euros

Celkovö darovanö úöstka: Euros
placeno: credit card öekem p›evodem
na úúet: "Institut Bruno Comby"

 

Datum :   Podpis :

To sign, you can sign the printed paper version if you print this page on paper and send it by fax or mail, or please type into this "Podpis" zone your name or any alpha-numerical code legally representing your signature, for example : /John Smith/ or /jsmith8492xfp8902/ if this page is transmitted electronically.

 

FIRST STEP : print and send this completed page

By clicking on the "Print" button, you will print this page. Whichever method of payment you are using, this page should be printed and sent by mail (with the cheque, if you pay by cheque), or by fax or by e-mail in the form of a PDF file (if you pay by credit card or electronic wire transfer). You can also use the "Print" button in the menu of your navigating software.

 

SECOND STEP : send your payment by one of the three following methods

Payment by credit card (in EUROS): 1/ fill out, print (on paper or PDF), and fax the printed paper form to +33 1 30 86 00 10 or e-mail the PDF form to ibc-cz[at]comby.org (spam prevention: replace [at] by @ in the e-mail) - 2/ click on the visa card logo : and follow the instructions. Most credit cards are accepted (Visa, Mastercard, American Express...). The amount of your payment will be debited from your credit card account. Do not send your credit card number to IBC, please make the payment yourself as indicated by clicking on the visa card above. The transmission of your credit card number is securized by https protocol.

Payment by wire transfer (in Euros): 1/ fill out, print (on paper or PDF), and fax the printed paper form to +33 1 30 86 00 10 or e-mail the PDF form to ibc-cz[at]comby.org (spam prevention: replace [at] by @ in the e-mail) - 2/ send an e-mail to ibc-cz[at]comby.org (spam prevention: replace [at] by @ in the e-mail) and ask for instructions concerning payment by wire transfer. You will receive instructions by e-mail.

Payment by cheque (in Euros): fill out, print, and send this membership registration form by traditional mail with your cheque. Cheques are to be denominated in EUROS and to be drawn on a French bank. If your bank is not in France, ask your banker to prepare a cheque drawn on a French bank. Eurocheques are not accepted.

According to the law, you have the right to access and correct the computerized information which concerns you.