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:
Bank address:
Swift number or BIC:

NLB d.d.
SI56 0204 5025 3583 120
Zavod za razvoj druzinske Medicine
Trg Republike 2, Ljubljana, Slovenia
LJBASI2X
 

You can fill this form, print it out and send it by fax/mail to EUROPREV at:

EUROPREV
nina.stojs@gmail.com

Fax: +386 1 43 86 910

 

 

 


© 2008 EUROPREV
Contact: Institute for development of Family Medicine - Medical Faculty, Department of Family Medicine
Poljanski nasip 58
1000 Ljubljana, Slovenia
Tel: + 386 1 43 86 914 - Fax: + 386 1 43 86 910 / email