European Network of (ex-) Users and Survivors of Psychiatry

Form for ENUSP Support Members

For support-member-organisations (& companies)

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, European Network of (ex-)Users and Survivors of Psychiatry, LAP, Vesterbrogade 103, 1.sal , 1620 Copenhagen V, Denmark , Phone: 0045 33261623,) or send the message as normal e-mail-text to enusp.info@gmail.com

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

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
Gabriela Tanasan