EUROCALL Membership Application Form

(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 €90

[ ] Corporate €225

[ ] Student/retired €55

* 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:

First Trust Bank, 33 The Diamond, Coleraine, N. Ireland
Sort Code: 938246 Euro Account Number: 09377040

BIC/SWIFT NUMBER: FTBKGB2B
IBAN NUMBER: GB28 FTBK 9382 4609 3770 40
(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, School of Languages, Literature, Culture and Communication, University of Limerick, Limerick, Ireland

Tel. +353 61 213495