Membership Application Form
Only for new members or address changes!!!

Yes I want to be a member of the Belgian Mathematical Society.

Name :

First name :

Address :

Postal code :   City :   Country :  

E-mail:

Occupation:

Fields of interest:

Workplace/University/Institute:

Please tick the appropriate lines:

I want to be an ordinary member of the BMS (EUR 20).
I apply for a BMS reciprocity membership (EUR 18); I am a member of the
In addition to my BMS membership, I want to be a member of the EMS (add EUR 25)
I agree that the Newsletter BMS-NCM News be sent to me by e-mail (as an attached .pdf file)
I agree that my e-mail address and affiliation are made public by the BMS.
I shall pay my dues on account number BE70 0011 7447 8525 of the BMS
I shall pay my dues on account number BIC: GEBABEBB / IBAN: BE70 0011 7447 8525 of the BMS (members living within the EURO zone).
I shall pay by PayPal by clicking here: Pay with PayPal. Remark: PayPal allows payment by credit card.

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