CEPINA

HOW TO BECOME A MEMBER

If you wish to become a member of CEPANI40, please fill in the Registration form here below.

You can also download the "Registration form" here and send it back to the attention of Miss. Emma Van Campenhoudt by using the following fax number : +32 (0)2.515.08.75 or by e-mail : evc@cepina-cepani.be


Name	*
First name	*
Date of birth	*
Office/Company/Institution
Address	*
Postal code	*
City	*
Country	*
Phone/portable	*
Fax
E-mail	*
Website

PLEASE TICK OFF AS APPROPRIATE : I expressly authorize Cepani npo having its seat at 1000 Brussels, Rue des sols n°8, to publish my name, first name, office and e-mail address on the website www.cepina.be be under the rubric members of CEPANI40. I do not authorize Cepani npo having its seat at 1000 Brussels, Rue des sols n°8, to publish my name, first name, office and e-mail address on the website www.cepina.be under the rubric members of CEPANI40.

(* = obligatory)