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  Mr/Mrs/Dr/Prof.:

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  First Name:
  Family Name:
  Institution:
  Position:
  Address:
  City:
  Zip Code:
  Country:
  Telephone:
  Fax:
  Mobile:
  Email:

    Cross your choice  :   

  1. INDIVIDUAL Membership fee 2008                                                                                       50

  2. INDIVIDUAL promotional membership fee registration for participants in 10th Conference ,      20

  3. INSTITUTIONAL membership fee                                                                                        150

  4. SPONSOR membership fee                                                                               min.            500

 

    Specify the beneficiary of your Institution :   

  Homeless people

  Mentally ill people

  Immigrants & Refugees

  Drugs Addicts  &  Alcoholics

  (ex) prisoners

  Unemployed

    Specify your interest in co-working with SMES-Europa in exchanges European projects :   

  A1.   Mental Helth &
         
COMMUNITY CARE  

 A2.   OUTREACH

 B JOB Rehabilitation &
      Social Cooperatives 

  C    MIGRANTS : health &
          participation

 Exchange & Research /Action

 Exchange & training

  Date:                      Sign: 

  

  SMES-EUROPA Statut : A.I.S.B.L non-profit International Association, Moniteur B.2002-01-15 N. 000620 "Arretée Royale" 10/08/01
 
SECRETARY :    Pl. Albert Leemans, 3 - B-1050 Bruxelles Tel./fax : (+) 32.2.5385887 E-mail : smeseu@smes-europa.org
 
ACCOUNT :   001.3629563.93,   IBAN  :  BE98001362956393,    SWIFT:   GEBABEBB
 
BANK :  Fortis Bank,   Av.Lepoutre 68 -  B-1050 Brussels