ESFR Registration and Feedback Form for Affiliate Institutional Membership

I am interested in supporting the ESFR and I want to become an affiliate institutional
member. I will transfer the membership fee of 500 EURO for the first year, and 400 EURO
for consecutive years to the ABN-AMRO bank mentioned below until one week after
registration.

ABN-AMRO Bank Nijmegen
Account Number: 54 11 01 935
Name of the holder: European Society on Family Relations
BIC Code: ABNANL2A IBAN: NL34ABNA0541101935

Institution/Organization/Firm*:
Representative*:Mr.Mrs.
Last Name*:
First Name*:
Affiliation of Representative:
Discipline /e.g., Psychology, Sociology, etc.):
Street*:
City*:
Postal code*:
Country*:
Phone:
Fax:
email:
Â