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 Secretariat, Zabel-Krueger-Damm 183, D-13469 Berlin) 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


Support member's data
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 want to be a ENUSP support member and will support ENUSP by giving the following donation:


I will transfer the money to the bank account of ENUSP: ABN AMRO in Utrecht, Netherlands, Account: 53.45.57.082 SWIFT: ABN-NL 2A / International Bank Account Number (IBAN): NL54 ABNA 0534 5570 82. Bank Identifier Code (BIC): ABNANL2A
I will send a cheque to ENUSP Desk, Zabel-Krueger-Damm 183, D-13469 Berlin. (Recommendation: Contact the desk first, to find a propper way to save bank fees.)
I prefer donating with credit card through PayPal. If you would like more information about this company before placing your transfer, visit them at www.paypal.com  Pay me securely with any major credit card through PayPal!   Visa MasterCard American Express Switch Debit Cards Solo Debit Cards Visa Delta Visa Electron eCheck
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


After receipt of your donation, the ENUSP Secretariat will promptly send a confirmation.

Kind regards
Peter Lehmann, Interim-Secretary of ENUSP