Newsletter #67-2021 20 Please print clearly SIS 2022 Membership Application Form European Structural Integrity Society 1 ST JANUARY 2022 to 31ST DECEMBER 2022 All members will be registered as Individual Members and will receive the ESIS Newsletter, at least once a year, by electronic delivery to the provided e-mail address. Membership Fees should be paid either by bank transfer or by Credit Card or by PayPal to the value of € 30 (Euros). Please put a cross (X) in the appropriate box(es) : Register me as an ESIS member for the year 2022 and send the ESIS Newsletters to the address stated below (in BLOCK CAPITALS please). Payment details. Since the membership fee is exceedingly cheap, PLEASE REGARD THIS FORM AS AN OFFICIAL INVOICE, noting that on receipt of your payment you will receive an official receipt plus your ESIS 2019 membership number. Enclosed is a PayPal payment receipt/details OR Enclosed is a copy of bank transfer for € 30 (Euros The bank is: Uncredit banca The name of the beneficiary is: ESIS (European Structural Integrity Society) the coordinates are: IBAN: IT22 N 02008 01160 000020016279 BIC SWIFT Code: UNCRITM1AG0 OR Please charge to my (delete as appropriate) EUROCARD / MASTER CARD / VISA CARD / DINERS CARD / AMERICAN EXPRESS CARD an amount of € 30 (Euros). My card number is: Exp — Date: Surname: Name Title(s) Affiliation: Address: e-mail: Tel No: Fax No:
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