Application-form

You can fill in this form and send it to us by clicking the SEND-button. An e-mail programme isn't necessary.

Mr. Mrs.

First name :

Surname :

Street :

Nr : Bus : Postal code :

City :

Telephone : Cellullar :

Fax :

E-mail :

Employer : (for students: studies)

Hereby declares to have read and agree with the objectives of the Belgian Euro-Atlantic Association.

Would like to apply to the department of :

Each gift of €30,- or more is tax deductable. Send me a receipt: yes no

I make deposit to the amount of € as members fee on bank account no. 000-0206941-40 of the BEAA.

I make a deposit to amount of € as a GIFT on bank account no. 000-0206941-40 of the BEAA.

Questions or remarks:

Euro-Atlantic Association of Belgium