| Please debit my Credit Card Visa
No [ ][ ... ][ ][ ] Expired date: ../ / .. For an amount equal to: [ ] 50 Euros (equivalent 50 to US$ annual individual membership fee) [ ] 200 Euros (equivalent to 200 US$ , annual institutional fee) (Check as appropriated) Titulars name and surname: . Date: . Signature: . |
This authorization should be faxed to: Barbara Wood. WMF Treasurer.
Fax: 35312800259
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