GAC-EPA Membership form

I wish to join* the GAC-EPA (Groupement des Anciens du CERN - ESO Pensioners' Association)

Title

first name

family name

I was formerly employed by

CERN ESO

Address:

street

country

postal code

city

Telephone

Mobile telephone

e-mail

check e-mail

(both e-mail addresses must be identical)

My subscription of 25 CHF per year will be paid by standing order (excluding any other mode of payment) with execution date of 7 January to a UBS account, the IBAN of which is CH47 0027 9279 C710 9245 0 and will also be sent by e-mail to me.

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* Art. 1.4 of the GAC-EPA Statutes states: "The Association is open to all beneficiaries of the Pension Fund, whether their retirement is effective or delayed, including widows, widowers and orphans"

Membership Application Form