EUROMICRO - The European Organisation for Information Technology and Microelectronics MEMBERSHIP APPLICATION FORM [ ] Yes, I wish to become a member of EUROMICRO for 57 EURO per year (renews automatically if not cancelled before end of the year) Name_______________________________________________________________ Company/Univ.______________________________________________________ Department_________________________________________________________ Address____________________________________________________________ City_______________________________________________________________ Country____________________________________________________________ Telephone_________________________ Telefax________________________ EMail______________________________________________________________ Payment will be made: 1. by credit card: [ ] Eurocard/Mastercard or [ ] Visacard Number_______________________________ Valid until _______________ CVC code________ (card validation code) is required by the credit card company. This is a code indicated on the back side of the credit card. Name of cardholder as printed on card______________________________ Sign. of cardholder________________________________________________ 2. By bank transfer: to account nr. 3207781 of Euromicro, Sparda-Bank West eG, Ludwig Erhard Allee 15, D-40227 Duesseldorf, Germany SWIFT code GENODED1SPK IBAN DE 69 370605900003207781 national bank code 370 605 90 Date ______________________ Signature ____________________________ Please enclose/transfer payment for 57 EURO and return the copy of this completed and signed form to: Euromicro office P.O. Box 2043 D-53743 Sankt Augustin Germany Fax: +49 2241 932 6746