Dutch Society for Wildlife Health

Please complete the form below to become a member of the Dutch Society for Wildlfe Health ( Vereniging Gezondheid en Welzijn Wilde Fauna).

Membership of the DSWH is 50 Euro per year (25 Euro for students).

All items in bold are requiered

Lastname:
Initials:
First name:
Titel:

Student:
Function:
Institution:
Department:
Street:
Number:
Postal code:
City:
Country:
Phone:
Fax:
Mobile phone:
E-mail:
Home address:
Street:
Number:
Postal code:
City:
Country:

Phone:
Fax:
Mobile phone:

Website:

Function within the DSWH:

Description of your activities in relation to the aims of Dutch Society for Wildlife Health:


Go back	Go forward

This site is maintained by JaDes	top