BlueBook 2009.qxd:1 - European Society of Pathology

The entries in this Handbook correspond with the ESP computer records as at July 1,
2009.
If any record is incorrect or incomplete, or if there is any change in the coming
year, please complete the following form and return it to the Office of the
Treasurer.
Thank you.
Please use block capitals
Member no.:
FAMILY NAME:
First Name(s):
Title: Prof. Dr. Other:
NEW ADDRESS
Name Institute:
Department:
Street:
City: Postcode:
Country:
Telephone: Telefax:
Email:
ESP HANDBOOK UPDATE FORM
OLD ADDRESS
Signature Date:
118
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Please complete the following form and return it to the Office of the Treasurer.
Please use block capitals.
Or fill out application form on the website: www.esp-pathology.org
FAMILY NAME:
First Name(s):
Place and date of birth:
Male Female
Title/Present Position: Prof. Dr. Resident
Other :
Please, clearly indicate which one of the following addresses should be used
for subsequent correspondence, mailings, and listing in the Members
Handbook:
Name:
Street:
PRIVATE ADDRESS
Postcode: City:
Country:
Name Institute:
Department:
Street:
APPLICATION FOR MEMBERSHIP OF THE ESP
INSTITUTE / OFFICE ADDRESS
Postcode: City:
TURN PAGE
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