INTERNATIONAL SOCIETY OF LIMB SALVAGE
Membership Renewal

PERSONAL DATA
  Mr. Ms. Title:
First Name:* Family Name:*
Institution: Department:
Street:* ZIP:
City:* Country:*
Phone:* Fax:
E-mail:* Please note that all further correspondence will be addressed to this email. Please make sure to provide us with a working address.
Date of Birth:*  
* Required fields  
MEMBERSHIP FEES (USD)
Membership 2017/2018 - Full members USD 100.00
Subsequent payment - Membership 2015/2016 - Full members USD 100.00
Subsequent payment - Membership 2013/2014 - Full members USD 100.00
Subsequent payment - Membership 2011/2012 - Full Members USD 100.00
PAYMENT MODALITIES
Bank Transfer: to the account "VMA-ISOLS" IBAN: AT28 2011 1294 4638 8600, BIC/SWIFT: GIBAATWWXXX, at the ERSTE BANK, Alser Str. 23, 1080 Vienna, Austria.
Credit card: We accept Mastercard and VISA.
Note
If making a bank transfer, please make sure to have it done free of charge for the beneficiary. Any charges for banking fees or incorrect remittance of membership fees will be invoiced by the administration office.
Please make sure that the member's name (matching with the name on the renewal form) is given on the bank transfer, as transfers bearing no name cannot be allocated.