Membership registration form: Euroscience association

Members Area

Contact

1 quai Lezay-Marnésia
67000 Strasbourg
Tel : +33 (0) 388 24 11 50
Fax : +33 (0) 388 24 75 56
Email : Please use our contact form

Online Registration

Please use the form below if you would like to register and pay your fees online. Fields marked with asterisks (*) are required. If you would rather register and pay via regular post mail, see the Payment Options page for more details.

Registration form

Account

Password *
Confirm password *
Membership category *

Personal Information

Title *
Last name *
First name *
Address *
Postal code * eg: 75000
City *
Regional code eg: BX4 7TY
Country *
Phone *
Fax
Email *
Web site
Nationality *
Gender *
Year of birth *

Work Information

Scientific field *
Profession
Organisation/Company
Department/Division

Euroscience Selections

Regional section *
Workgroup *
Joint agreement If yes, complete the following two fields
Organization
Registration Number
Publish your name in membership list?
Past ESOF you have attended
Select all that apply (use Ctrl-click)
Your reason for joining Euroscience is...
Your interest in science is...
Copy security code *

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