ESFR Registration and Feedback Form for Affiliate Individual Membership

I am interested in supporting the ESFR and I want to become an affiliate individual
member. I will transfer the membership fee of 75 EURO to the ABN-AMRO bank
mentioned below.

Bank: ABN-AMRO Bank Nijmegen (The Netherlands)
Bank account number 54 11 01 935
Name holder: European Society Family Relations
BIC code ABNANL2A IBAN NL34ABNA0541101935

Please select*:Mr.Mrs.
First Name*:
Last Name*:
Title:
Affiliation:
Discipline (e.g., Psychology, Sociology etc):
Please indicate*:private addressinstitutional address
Street*:
City*:
Postal code*:
Country*:
Phone:
Fax:
email:
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