BSRM membership

Membership fees

Note: Annual membership runs from 1 January till 31 December

Clinician & Reproductive biologist : 75 Euro (incl. 21% VAT)
Paramedical, Resident in training, Students (Master, PhD, post-doc..) : 40 Euro (incl. 21% VAT)

Member information

First Name*

Last Name*

Title*

Institute

Street - number*

Zip Code*

City*

Country

Vat Number

Email*

Date of birth

DayMonthYear

Language

RIZIV number

Format 1-12345-12-340

Invoice address

invoice address is different from the information provided above

Invoice Company

Invoice Department

Invoice Street & Number

Invoice Zip Code & City

Invoice Country

Invoice VAT Number

Invoice Remarks

Membership category*

Payment method:*

Bank transferVisa / Mastercard

Calculation

Total

EUR

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Payment policy
Full payment has to be made to the BSRM account with reference: “Name + membership”. IBAN number: BE79 3101 2631 7833, BIC: BBRUBEBB, Bank: ING.

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