Do send us the following information:
| _______________ | ___________________________________________ |
| Title: | . |
| First Name: | . |
| Last Name: | . |
| Institution: | . |
| Address: | . |
| . | . |
| . | . |
| Mailing Address if different from above: | . |
| . | . |
| We cannot accept credit card payments at the moment | . |
| Expiry Date: | . |
| Name as on card, if different from above: | . |
Signature: | . |
| _______________ | ___________________________________________ |
| Back to the EBJ page | - last update: 22 Aug 2002 MAF - | Back to top |
