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FEDORA APPLICATION FORM - FORMULAIRE D'INSCRIPTION

This form is currently inactive - please post  or email applications to:

Ms Paula Ferrer-Sama

FEDORA SECRETARY
National University of Distance Education
School and Career Guidance Office
C/ Rios Rosas, 44-A
E - 28003-Madrid, SPAIN

Tel: +34 91 398 75 18
Fax: +34 91 398 75 17
Email: pferrer@pas.uned.es


NAME - NOM

FIRST NAME - PRÉNOM

GENDER - SEXETITLE - TITRE
M   FPROF  DR

JOB TITLE - FONCTION

ORGANISATION - ORGANISME

 

ADDRESS - ADRESSE

POST CODE - CODE POSTAL TOWN - VILLE

COUNTRY - PAYS

PHONE - TÉLÉPHONE

FAX

E~MAIL

WORKING GROUP

WORKING LANGUAGE - LANGUE DE TRAVAIL

ENGLISH    FRANÇAIS

MY FEDORA MEMBERSHIP FEE:
 Full membership 70 Euros
 New EU member state 50 Euros
 Institutional membership 200 Euros
 Company membership 500 Euros

HAS BEEN TRANSFERRED TO:
 Credit Lyonnais
 VISA
 CCP Bruxelles
 EUROCARD/MASTERCARD

 

OR - OU