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BlueBook 2009.qxd:1 - European Society of Pathology

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120<br />

Application for Membership <strong>of</strong> the <strong>European</strong> <strong>Society</strong> <strong>of</strong> <strong>Pathology</strong>.<br />

Country:<br />

Telephone:<br />

Telefax:<br />

Email:<br />

FIELDS OF INTEREST<br />

Date:<br />

Signature <strong>of</strong> Applicant:<br />

CONTINUED<br />

Please return this form to:<br />

The Office <strong>of</strong> the Treasurer<br />

Pr<strong>of</strong>. Dr. J.H.J.M. van Krieken<br />

Dept <strong>of</strong> <strong>Pathology</strong> (824 PA)<br />

P.O. Box 9101<br />

6500 HB NIJMEGEN<br />

The Netherlands<br />

Fax: +31 24 366 87 50<br />

Your acceptance as a member <strong>of</strong> E.S.P. will be confirmed in due time.<br />

This Application for Membership can also be downloaded from our website:<br />

http://www.Europathology.org<br />

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