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European Macrophage and Dendritic Cell Society

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					Annual Membership Fees: € 25



                                European Macrophage & Dendritic Cell Society

                                  Registration form
                Name:
            Institution:
                Street:
                   City:                                           Postal Code
              Country:
               Phone:
                   Fax:
                 Email:
                  URL:

Research Interests:        1.
                           2.
                           3.
         Technologies:     1.
                           2.
                           3.


                 Date:                      Signature:

You can either pay membership fee of 25 €


 By money transfer

A) Direct Debit, when you are from a European Country. Please use SEPA form on the web page and
send it together with this application form

B) Single payment
IBAN DE40-750 500 000-780 011 201                                  BIC BYLADEM1RBG

 Or by allowing us to charge your credit card (Eurocard/Mastercard or Visa only !!)


Please, charge my credit card

 Eurocard/Mastercard               VISA
card number :                                            expiration date :
card verification code CVC2 (3-digit)
Date :                                                         Signature :




Send fax or pdf to:
Silvano Sozzani
Dept Biomedical Science Biotechnology
University of Brescia,
25123 Brescia, Italy                  Fax: +39-030-371-7747                      sozzani@med.unibs.it

				
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