| To be mailed, send en pay before July 15th 2006 to:
Info number call: +31 6 188 345 02 or e-mail to: Henk Bril
Payments to:
Ned. ver. Waarnemers v. Sterbedekkingen
Benedendorpsestraat 18
7038 BC Zeddam
Postbank Account nr 836 56 00
IBAN code NL97 PSTB 0008 3656 00
BIC PSTBNL21
Keywords: ESOP 2006 and P/your name
Or : ESOP 2006 and S/your name
Please print legibly!
Or download and use the PDF  or Print Version.
Title: (Prof. Dr. Mr. Mrs. etc): ____
Fees:
O Member of DOA € 75.00 (€ 100.00) (mark P)
O Member of IOTA-ES € 75.00 (€ 100.00) (mark P)
O Partner of Member € 35.00 (€ 45.00) (mark S)*
O Non Member € 225.00 (€ 250.00)
O New Member of DOA for 2006/2007 € 30.00
O New Member of IOTA-ES for 2006/2007 € 40.00
Between brackets after July 15th
Full name:
______________________________________________________
Address:
______________________________________________________
Town:
______________________________________________________
Zip code:
______________________________________________________
Country:
______________________________________________________
Telephone:
______________________________________________________
E-mail:
______________________________________________________
Web page **:
http://________________________________________________
Name and signature:
______________________________________________________
Date:
______________________________________________________
* Partner program is Buffet and Tour in Observatory only.
** We place link on this site of your site.
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