Membership - Application Form

Please make sure that you fill in your details for the fields marked *

Preferred username: *	Password: *
	Repeat:
Salutation:
First name: *	Last name: *
Address:	Postal code: City:
Country:
Telephone:	Fax:
Organization:	Website (without http://):
E-mail: *	Name of EBBF member proposing you

Where did you learn about EBBF? web search EBBF member EBBF publication EBBF event Other

Personal Profile: describe your work/education experience, your present position, other significant activities, hobbies, personal interests.
What is your position & field of work?
Is there an issue that EBBF could help you solve?
Would you like to participate and contribute to the mission and activities of EBBF? How?
Which is the area that interests you most?
Which is the EBBF membership level you wish to join at
Your photo: