ESFR Registration and Feedback Form for Full Individual Membership

I am interested in supporting the ESFR and I want to become a full individual member. I will transfer my
payment of 50 EURO (special congress discount, regular fee EURO 65) for the first year of my membership to

the temporary bank account of the ESFR.
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.
Last Name*:
First Name*:
Title:
Affiliation:
Discipline (e.g., Psychology, Sociology etc.):
Mailing address - please indicate*:private addressinstitutional address
Street*:
City*:
Postal code*:
Country*:
Phone:
Fax:
email:
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