ESMS Associate member BANK TRANSFER

Name:*

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

Zip/Postal Code:* Zip/Postal Code is Required

Organisation : Organisation is not valid

Institute: Institute is not valid

VAT: VAT is not valid

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Bank Transfer

Please note that an additional administrative fee of €17 applies to memberships paid via bank transfer. Bank Transfer details: Sydbank, Kongens Nytorv 30 DK-1050 Copenhagen K, Denmark Account No.: 8075 – 0009 424 585 IBAN: DK73 8075 0009 424 585 SWIFT/BIC: SYBKDK22 When making a bank transfer, please include your full name and username in the payment reference and send the proof of payment to info@esms-mohs.eu. Payment must be completed within 7 days of receiving the invoice. You will receive a confirmation message once we have verified your payment.

No val Please fix the errors above

Pay ESMS MOHS

	ESMS Associate member BANK TRANSFER – Payment	€67.00
	Total	€67.00

ESMS Associate member BANK TRANSFER – Payment

€67.00

Total

€67.00