NCS - Order form

Nederlandse Commissie voor Stralingsdosimetrie
Netherlands Commission on Radiation Dosimetry

Print this page and send it to:

Mr. E. van Dijk
Netherlands Measurements Institute
P.O. Box 654
2600 AR, Delft
The Netherlands

ORDER FORM


Quantity	Report number and title	Cost (€)



	Subtotal
I live in Europe	I live outside Europe
	postage and packing
	banking cost (if relevant)

	TOTAL: €

Description of selected report..

Payment by:	Cheque order made payable to Netherlands Commission on Radiation Dosimetry (banking costs: € 7.50)

	Postal order made payable to Netherlands Commission on Radiation Dosimetry (banking costs: € 7.50)

	I am living in The Netherlands and will transfer the cost to ABN-AMRO bank account 51.70.64.332 in the name of St. Nederlandse Commissie voor Stralingsdosimetry (no banking costs)

	I am living in Belgium and will transfer the cost to BACOP bank account No 777-5973632-60 in the name of the 4th NCS Lustrum 1560 Hoeilaart (no banking costs)

	Please charge my Eurocard

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	Please charge my Mastercard

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	(*) CvC = Card Validation Code = last three digits of the number in field of your signature. Sorry, other credit cards can not be accepted.

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Name:
Address (of the credit card):
Zip / postal:
City and Country:

E-mail address: (optional)
Comments:	Write down your comments here..
Sign:
Date (dd/mm/yyyy):