EUROPREV - european network for prevention and health promotion
 

 

    
 
Europrev membership form
 

 
   
 
 

 
   
Professional Title:
First Names or Initials:
Family Name:
 
Clinical Practice: Research:
Teaching: Other:
 
Mailing address:
Institution:
Street:
City: State:
Country: Post Code:
Telephone (Office): Telephone (Home):
Facsimile: E-mail:
   
   
Your areas of special interest in prevention and health promotion:
   
Date: dd/mm/yyyy
 
 
SUBSCRIPTION

I wish to join to Europrev:
I wish to order Individual Subscription
 50 Euros
I wish to order Subscription from Public Institution, Scientific Society or National College 200 Euros
I wish to order Subscription from a Private Institution
 2000 Euros



 
 
 

You can make the subscription sending the amount through bank transfer to:

Bank:
Account number:
Accountholder:
La Caixa address:
Swift number:

 La Caixa, Barcelona, Spain
2100-0965-59-0200080092
SemFYC-EUROPREV
Portaferrissa, 23. 08002 Barcelona (Spain)
CAIXESBB
 
You can fill this form, print it out and send it by fax/mail to Europrev secretariat:

EUROPREV
Portaferrissa, 8
08002 Barcelona (Spain)

antonia@semfyc.es
cbrotons@eapsardenya.cat
Telephone: +34.93.317.03.33
Fax: +34.93.317.77.72
http://www.europrev.org
 

 

 


© 2004 EUROPREV
Contact: Portaferrissa, 8 · 08002 Barcelona (Spain)
Phone: +34 93 317 03 33 / Fax: +34 93 317 77 72 /europrev@semfyc.es