MEMBERSHIP FORM FOR MEMBER ASSOCIATIONS Name: AFPS-FRENCH EARTHQUAKE ENGINEERING ASSOCIATION Country: Number of Members: France 650 Delegate Name: Didier COMBESCURE Afps Mail Address: 15, Rue De La Fontaine Au Roi 75127 Paris Cedex 11. Phone: e-mail: 00 33 1 44 58 28 40 didier.combescure@f4e.europa.eu Fax: Web page: 00 33 1 44 58 28 41 http://www.afps-seisme.org/ YES NO Membership with Paper Copy Subscription: 2015: 650 Amount in Euro: 2016: 650 euros For the Years +22 euros in case of Bank transfert (Membership due is 1 Euro per Member with minimum of 100 Euros, if paper copy is not preferred minimum is 50 Euros) Payment by VISA or MasterCard Card Holders Name: Card Type: VISA: MASTERCARD: Card Number: Expiration Date: / Card Holder’s Signature: Date: YES NO Automatic Renewal of Membership only for payment with credit cards Please fill out the form, sign it and fax it to Central Office (Fax: +90 212 203 1127) or scan it or convert the doc file to pdf file and send it as e-mail attachment to ansal@boun.edu.tr. Please mail the original signed form to: Prof. Atilla Ansal, President of EAEE , Kandilli Observatory and Earthquake Research Institute Çengelköy, For the payment by bank transfer the account name and related information: Avrupa Deprem Mühendisliği Birliği (European Association for Earthquake Engineering) Garanti Bank, Bogazici University Branch, Istanbul Campus, Bebek, Branch No: 303, Account No. 9090519 SWIFT Code: TGBATRIS – IBAN No: TR33 0006 2000 3030 0009 0905 19
MEMBERSHIP FORM FOR MEMBER ASSOCIATIONS Name: AFPS-FRENCH EARTHQUAKE ENGINEERING ASSOCIATION Country: France Number of Members: 650 Delegate Name: Didier COMBESCURE Mail Address: Afps 15, Rue De La Fontaine Au Roi 75127 Paris Cedex 11. Phone: 00 33 1 44 58 28 40 e-mail: didier.combescure@f4e.europa.eu Fax: 00 33 1 44 58 28 41 Web page: http://www.afps-seisme.org/ Membership with Paper Copy Subscription: YES NO Amount in Euro: For the Years 2015: 650 2016: 650 euros +22 euros in case of Bank transfert (Membership due is 1 Euro per Member with minimum of 100 Euros, if paper copy is not preferred minimum is 50 Euros) Payment by VISA or MasterCard Card Holders Name: Card Type: VISA: MASTERCARD: Card Number: Expiration Date: / Card Holder’s Signature: Date: Automatic Renewal of Membership only for payment with credit cards YES NO Please fill out the form, sign it and fax it to Central Office (Fax: +90 212 203 1127) or scan it or convert the doc file to pdf file and send it as e-mail attachment to ansal@boun.edu.tr. Please mail the original signed form to: Prof. Atilla Ansal, President of EAEE , Kandilli Observatory and Earthquake Research Institute Çengelköy, For the payment by bank transfer the account name and related information: Avrupa Deprem Mühendisliği Birliği (European Association for Earthquake Engineering) Garanti Bank, Bogazici University Branch, Istanbul Campus, Bebek, Branch No: 303, Account No. 9090519 SWIFT – Code: TGBATRIS IBAN No: TR33 0006 2000 3030 0009 0905 19
NationalMembershipForm2015.docx