EPNOE Individual Membership Request Form

Yearly membership fee for individual members is 150€ for professionals, 50€ for students and PhD students (please provide proof).
By submitting this form I declare to join as Individual Member of the EPNOE Association, IMT Mines Alès, 6 avenue de Clavières, 30319 Alès Cedex, France, declared under law of 1901 on December 14th 2007 and published in the French “Journal Officiel” on January 5th 2008 under number 1006, and accept its statutes.
Membership is effective for the current calendar year upon payment of the annual membership fee.

First Name

Last Name

Job title

I am

I am a student/PhD student

University/Research Organisation/Company

Street Address

Address Line 2

City

Postal Code

Country

Address Invoice (if different from above)

VAT (if required)

Purchase Order Number is needed on invoices

I need a purchase order number on the invoice

Message

GDPR

My data may be stored according to GDPR *

* mandatory field

EPNOE Individual Membership Request Form

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