ISCOWA
Tempelierhof 5
3544 NA Utrecht
The Netherlands.
![]() | I herewith declare to want to become a member of ISCOWA, The International Society for the Environmental and Technical Implications of Construction with Alternative Materials, and to observe its Statutes. |
Name:
Affiliation:
Full Address:
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Telephone: |
Telefax: |
E-mail: |
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Signed at (place): |
Date: |
Signature: |
I will pay my membership fee of EUR 50.- (= ca. UK£ 42 / US$ 63 ) for 2011 as follows:
[ ]Yes, as new member, please send me the ISCOWA/Wascon 2003 CD-rom for only EUR 25. (please check box)
[ ]Preferred method: I will deposit € 50.-- (or € 135 for 3 years) into ISCOWA's International Bank Account Number (IBAN): we will send you an invoice with our bankaccountnr. after reception of this form.
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[ ] Charge my [ ] American Express or [ ]VISA or [ ]MasterCard credit card for [ ] € 50 (year 2011) or [ ] € 135 (years 2011, 2012, 2013) + € 25 for the CD-rom if checked.
Please fill in your credit card information:
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Credit Card nr: |
(the 3 extra digits at the back of your credit card)
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Expiration date: |
Name as stated on the credit card:
Address to which the credit card is registred:
Please include ZIP or postal code!
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Date: |
Place: |
Signature: |