NADB Subscription Form

(* = mandatory fields)
Organization/Company:	*
Dept.:	*
Contact:	*
Address (Street & No):	*
P.O. Box:
City:	*
State/Province:
Zip/Postal Code:	*
Country:	*
Phone:	*
Fax:
E-Mail:	*
Number of subscriptions:	*	1 subscription = EUR 1,500 2 subscriptions = EUR 2,500 3 subscriptions = EUR 3,350 4 subscriptions = EUR 4,200 5 subscriptions = EUR 5,000 6 subscriptions = EUR 5,500 7 subscriptions = EUR 6,000 8 subscriptions = EUR 6,500 9 subscriptions = EUR 7,000 10 and more = EUR 750 each
Total amount in EUR (€):	*
Date:

Payment Method:
	Bank transfer to NAMSA's account with BCEE in Luxembourg: IBAN: LU14 0019 1007 7845 4000 BIC: BCEELULL (IBAN = International Bank Account Number) (BIC = Bank Identifier Code / SWIFT Code)
	Cheque payable to the order of "NAMSA-Finance Division"
	EuroCard/MasterCard (see NOTE below)
	Visa Card (see NOTE below)

For credit card payments only:
Holder:	.................................................................
Number:	.................................................................
Expiry date:	.........................................
CVV2 no.:	............	On the back of the card, in the signature area, is your credit card number followed by the 3 digit CVV2 security number ( Click here to view image)
Signature:	.........................................
We accept the subscription terms & conditions