EFN - 会員登録用紙

Association of Environmentalists For Nuclear Energy の会員になるためには

Environmentalists For Nuclear Energy
55 rue Victor Hugo, 78800 Houilles, France
E-mail: jp[at]ecolo.org (spam prevention: replace [at] by @)

Phone: +33 1 30 86 00 33 - Fax: +33 9 55 29 00 22

名 前* : 名 字* :
住 所* :
郵 便番号* : City* :
国 名* : E-mail* :
電話 : Fax :
職業 :
(*) 必須記入事項

私 は、以下の区分で1年間の会員新規登録または会員登録更新を希望します。

支援会員: 私は あなた方の活動に賛同し ます。 (無料 -ファクスでEFNへ送付して下さい)

賛同会員:   5,000 YENS (JPY)
活動会員: 10,000 YENS (JPY)
寄付会員: 15,000 YENS (JPY)

会費を支払っていただいた会員の方には郵便で領収書を 送付いた します。新しく会員になられる方は、EFN理事会による承認が必要になります。EFNの電子メールリス トにより連 絡させていただきます。

私は、次の地域の地方通信員になることに 同意します。 
協会支援のための追加寄付 :  Euros

合計金 額:  YENS (JPY)
支払方法の選択  クレジットカード 小切手  電信送金

送金先: "Environmentalists For Nuclear Energy"

日付 :          署名 :

FIRST STEP : fill out, print and send this page to EFN

After completing this form, select your printer (or PDF format) and click on the "Print" button to print this page. You can also use the "Print" button in the menu of your navigating software. 

This page can be printed either : 1/ on paper, in this case, fax the paper-printed form to +33 9 55 29 00 22 or 2/ to a PDF file (using ACROBAT WRITER or a similar software), in this case send the PDF file to jp[at]ecolo.org (spam prevention: replace [at] by @)

Sign the printed paper version if you print this page on paper and send it to EFN by fax, or type your name or any alpha-numerical code legally representing your signature, for example : /HiromichiYageta/ or /hyageta8492xfp8902/ into the "signature" zone, if this page is printed to a PDF file and sent to EFN by e-mail.


SECOND STEP : send your payment to EFN by one of the three following methods

Payment by credit card (in JPY): click on the visa card logo below (choose your currency), type the amount of your membership in the appropriate box, and follow the instructions. Most credit cards are accepted (Visa, Mastercard, American Express...). The amount of your payment will be debited from your credit card account. Do not send your credit card number by fax to EFN, please make the payment yourself as indicated by clicking on the visa card icon below. The transmission of your credit card number is securized by https protocol.

click here: for payment by credit card in Japanese Yen (JPY)

Payment by wire transfer (in Euros): send an e-mail to jp[at]ecolo.org (spam prevention: replace [at] by @) asking for instructions concerning payment by electronic wire transfer. You will receive instructions by e-mail.

Payment by cheque (in Euros): send this membership registration form printed on paper by traditional mail with your cheque to : Environmentalists For Nuclear Energy, 55 rue Victor Hugo, 78800 Houilles, France. Cheques are to be denominated in EUROS and to be drawn on a French bank. If your bank is not in France, ask your banker to prepare a cheque drawn on a French bank. Eurocheques are not accepted.
You may determine Japanese Yen (JPY) into EUROS or other currencies by using EFN's currency converter : click here to open the currency converter (opens a new window containing the converter)

According to the law, you have the right to access and correct the computerized information which concerns you.