Bank Transfer - Membership

Please fill the form.

Name and Surname *

E-Mail *

Membership Type *

Ordinary Membership 2014/2015 - €150,00 (For new Members Only)

New Student Membership (only till age 25) - 2014/2015 €40,00 (For new Members Only)

Ordinary Membership 2015 - €120,00

Student Membership (only till age 25) 2015 - €

Billing Information (Dati Fatturazione) *

Please add Proof of Payment - Allegare Copia Bonifico *

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BANK TRANSFER DATA:

IBAN: IT35H0326812100052449966560

BIC (Swift code): SELBIT2BXXX

To: Accademia Europea di Ortocheratologia – EurOK

Banca Sella S.p.a. - Via San Marco 11/C – 35129 Padova (PD)

Please specify the Full Name of the Member in the Bank Tranfer

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