EUROCALL Membership Application Form 2008

(NB: you can now also subscribe via online credit card payment.)

Please print and complete this form, and post or fax it, with the appropriate membership fee, to the address/fax at the bottom of the form.

Please indicate here, if this application results from activities by your national/regional EUROCALL representative:

Country:

Name of representative

Please register me as a member of EUROCALL for one year as follows:

(Please tick as appropriate)

[ ] Individual €85

[ ] Corporate €200

[ ] Student €50

* Student applications must be accompanied by a letter of nomination from their educational institution - which must also be registered as a Corporate Member.

I enclose (please tick as appropriate)

[ ] Cheque (in euros only), drawn on an Irish bank and made payable to EUROCALL

[ ] Evidence of a bank transfer to:

AIB Bank, University of Limerick, Castletroy, Limerick, Ireland
Sort code: 93-01-48 Euro Account No: 16557093

BIC: AIBKIE2D IBAN: IE33AIBK93014816557093
(Please insert to ensure quick secure transfer within the euro zone.)

Contact name for Corporate or Commercial Members:

Institution:

Address:

Telephone:

Fax:

Email:

In order to comply with the Data Protection Act, we require your permission to pass on your contact details, solely within the EUROCALL organisation. Please sign the declaration below:

I agree that my contact details may be passed to colleagues within the EUROCALL organisation.

Signed:

EUROCALL, Dept. of Language & Cultural Studies, University of Limerick, Limerick, Ireland

Tel. +353 61 213495 Fax. +353 61 202556