Application Form

Application Formepu452022-05-08T10:16:32+00:00

PLEASE RETURN THIS FORM TO:

Tine Tournicourt (EPU Treasurer)
Zepestraat 4, B 8952 Heuvelland – Wulvergem, Belgium
Email: tournicourttine@gmail.com

FEES SHOULD BE PAID TO:

EPU

Belfius Bank BE82 0689 0354 9468, Belgium
Ac no. 689-0354 9468
IBAN: BE82 0689 0354 9468
BIC: GKCCBEBB
Name of account holder: European Polio Union

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