EVRS - Evrs Members

EVRS MEMBERS

New Members inscription :
How to register : click here
( * : required datas )

Last Name : *
First Name : *
Birth Date :
Country : *
Office Address : *
Office Zip Code : *
Office City : *
Surgery Address : *
Surgery Zip Code : *
Surgery City : *
EMail : *
Phone : *
Fax :
Member :
First sponsor (click for info.) :
Second sponsor (click for info.) :
Number of Retinas per Year :
Comment :

Payment Options
Payment by credit card is online only but if you wish you can send a check for the order of "EVRS" to :
EVRS, 8 Rue Camille Flammarion, 44000 Nantes, FRANCE together with this form.
Contact us for other payment option: contact@evrs.org
Other Payment
Regular Member	120 Euros

Member in Training	50 Euros