Form for ENUSP Support Members

If you have installed a web-based service as pre-adjusted e-mail-application (for example Yahoo-mail or Hotmail), then our form will probably not work. In this case we kindly ask you to print the form and send it by fax (+49 30 4039 8752) or letter (address: ENUSP, Zabel-Krueger-Damm 183, 13469 Berlin, Germany) or send the message as normal e-mail-text to desk@enusp.org

If you want to become an ordinary member of ENUSP, please click here

I want to be a ENUSP support member
First name
Family name
c/o
Building
Street & house no.
Country
Zip code
City
State
E-mail
Web site
Fax
Phone
User / Survivor ?
About myself

I will support ENUSP by giving the following donation:
I will transfer the money to ABN AMRO in Utrecht, Netherlands, Account: 534557082, Sort Code: ABN-NL 2A
Account holder: Vereniging European Network
Transnational payments: International Bank Account Number (IBAN Code): NL54ABNA0534557082, Bank Identifier Code (BIC / Swift Code): ABNANL2A
Bank's postal address: ABN AMRO, Neude, Postbus 30, 3500 AA Utrecht, The Netherlands
I prefer paying our membership fee with credit card through PayPal to desk@enusp.org  Pay us securely with any major credit card through PayPal!   Visa MasterCard American Express Switch Debit Cards Solo Debit Cards Visa Delta Visa Electron eCheck
 
If you would like more information about PayPal before placing your transfer, visit them at www.paypal.com
Please make my name anonym in that part of your book-keeping, which is open for the public.

I prefer another form of support (for example in-kind-support, volunteer work like translation, building links to media or politicians):


Only in case the donation is for a special issue:

Please confirm the arrival of my mail and of the donation not to the sender's address of this mail, but to this alternative e-mail address:

Additional remark:


In the name of ENUSP board,
kind regards
Peter Lehmann, Secretary of the ENUSP Board