ICLN Registration Form

Please complete this registration form if you want to become a Private Member of ICLN. A welcome letter will be sent to you as soon as possible. The membership will be continued automatically for the next calendar year, unless written notice is given at least one month preceding the new calendar year.

 
Last Name

Title(s)  

Male    Female
First name
Organisation
Position
Address
Country
Telephone Fax
Mobile
E-mail
   
 I want to become a member of ICLN € 95 / year*
 *Excluding 19% VAT.

 

Please print the completed registration form and fax it to: +31 70 362 97 68

 

or send it to:

 

ICLN

Koninginnegracht 22

2514 AB The Hague

The Netherlands