EUCC Membership Application Form

EUCC Membership / Partner Application Form

Name:

Organisation:

Address:

Postal code and Town:

Country:

Telephone number:

Fax number:

E-mail:

Website URL:

I would like the following membership/partner option: (Please tick accordingly)

	Friend of the Coast for 1 year	euro 24
	Private & Student member for 1 year	euro 48
	Private & Student member for 3 years	euro 80
	Professional member for 1 year	euro 65
	Professional member for 3 years	euro 120
	NGO member organisation for 1 year	euro 65
	NGO member organisation for 3 years	euro 120
	Member Organisation for 1 year	euro 300
	Member Organisation for 3 years	euro 500
	Communication Partner for 1 year	euro 1000
	Programme Partner for 1 year	euro 2000

Yes, I want to receive the bimonthly newsletter Coastal&MarinE-news or equivalent on the above email address

Some space for comments or questions:

You can also print and mail or fax this form to:

EUCC
PO Box 11232
2301 EE Leiden
The Netherlands
Fax: + 31.71.5124069