ANNUAL DUES STATEMENT - 2009


Membership No.

First Name *
Middle initial
Last name *
Permanent address *



Telephone
Fax
Email *

Emeritus Membership (if you are over 65): (please select appropriate option) Non applicable No subs to pay but wish to remain on mailing list € 40,00 & still receive the Journal


Annual dues for 2009: € 80,00

WAYS TO PAY (PAYMENT BY ELECTRONIC BANKING IS THE PREFERRED METHOD)

	1.	Electronic banking (always use the IBAN and BIC code) Please transfer your money to: ISSHP, Hanzeplein 1 9713 GZ Groningen IBAN: NL55ABNA0599275464 BIC: ABNANL2A
	2.	Cheques should be made payable to: ISSHP, Attn. Gerda Zeeman, Secretariaat Obst/Gyn, CMC V, Room Y.4169 CB20 Hanzeplein 1 9713 GZ Groningen The Netherlands
	3.	Creditcard You can pay by creditcard using Paypal. In order to use this system you have to open a Paypal account on www.paypal.com. Click on ‘sign up now’ and open a ‘personal account’ » fill in the necessary fields and click on ‘I agree. Create my account’. You’ll be sent an e-mail in which you’re asked to confirm your e-mail address. After that you’ll be able to use your account. Click on ‘Send money’ and fill in the following details: ‘to:’ s.breur@erasmusmc.nl; ‘currency’: euro, ‘for’: service/other. Your money will directly be sent to the ISSHP. You can close your account again right after you’ve paid your Annual Dues.

(please tick appropriate box on the printed form)

Gerda Zeeman, Secretary/Treasurer (ISSHP) Dept. Obstetrics & Gynaecology CMC V, Room Y.4169 CB20 UMC Groningen P.O. Box 30.000, 9700 RB Groningen The Netherlands Fax: +31 50 361 1806 E-mail: s.breur@isshp.com