EATCS Membership Application

Name:
 
First name:
 
Email:
 
Mailing Address:
 
 
 
 
Date:
Signature:
 
Membership fee: EURO                     for       year(s)
Mail delivery: EURO
Total amount: EURO

Method of payment

[  ] Please charge my credit card:

(  ) Eurocard/Mastercard (  ) Visa

Card number (16 digits):
Expiration date:
Address: (when different from mailing address above)
 
 
Signature:

 

[  ] Check Enclosed

[  ] Transferred to EATCS account

[  ] Cash Enclosed

[  ] ACM SIGACT Member number: