Application form for the membership in ICEVI-Europe

Personal information

First Name:

Surname:

Street, No.:

City, State:

Country:

Phone/Fax:

E-mail:

Profession:

Organization's information

Organization:

Brief Description:

Organization - Street, No.:

Organization - City, State:

Organization - Country:

Organization - Phone/Fax:

Organization - E-mail:

Type of membership

Yes, I ask for membership. Please mark your membership group:

Individual member from Balkans, Eastern and Central Europe 15 Euro per year / 60 Euro for 4 years

Individual member from rest of Europe 30 Euro per year / 120 Euro for 4 years

member organization without own budget 200 Euro per year

member organization with less than 100 employees 350 Euro per year

member organization with between 100 and 200 employees 500 Euro per year

member organization with more than 200 employees 800 Euro per year

If there is anything else you want to write to us about

Notes:

Any problems to fill the form on-line?

You may fill in this form on-line or if you have any problems with filling this on-line form, please download the application form ( ZIP format, 8,6kB), fill it off-line and send to the Office of ICEVI-Europe:

ICEVI-Europe

Dr John Ravenscroft
Professor and Chair of Childhood Visual Impairment
President of ICEVI-Europe
The Moray House School of Education and Sport
Holyrood Road
The University of Edinburgh
Edinburgh
UK
EH8 8AQ

tel.: +44(0)131 651 6181
Office e-mail: