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IMAPS Nordic Membership Form 2004

Please print out and fax to +358 8 5515771, Attn: Terho Kutilainen

Name

Company

Address

Country

Telephone

Fax

E-mail

Membership is personal, but may be transferred to another person within the same company. If you are already a member you will receive an invoice. Payment by credit card or transfer to giro accounts are accepted. In the Nordic countries, Postgiro to the IMAPS account in your country is preferred. Please note that BANK CHECKS ARE NOT ACCEPTED, and will be disregarded. If paying by credit card, EUR currency must be used.

I am paying by giro or bank transfer to IMAPS Nordic.

Finland: EUR 78 to account no 800012-70837520,
Denmark: DKK 580 to account no 901-4934,
Sweden: SEK 705 to account no 85 12 49-3,
Norway: NOK 654 to account no 7874 0705 317

I am paying by credit card, in EUR only.
Eurocard Visa Mastercard American Express

Card no: Expiry Date CVC/CVV*

Cardholder’s name

Billing address, if not the same as above

Cardholder’s signature ………………………………………….……………………………

Total amount due: EUR 78 


* Users of Eurocard, Mastercard, and Visa are requested to inform the CVC/CVV identification number (three last digits on the backside of the card in the signature field). For details please contact your card issuer.

 


2005-08-08   IMAPS Nordic start page   Webmaster