GAC-EPA Membership Update form

I wish to update the information the GAC-EPA has about me

(explanations for filling in this form)

(fill in only what has changed, but you MUST give your title, first and last name)

Personal details

title

first name

family name

I was formerly employed by

CERN ESO

last division/department

date of birth:

nationality:

Postal Address

number

street

country

postal code

city

Communication

Telephone

(optional)

Mobile telephone

(optional)

e-mail

re-type e-mail:

(both e-mail addresses must be identical)

communication preference

Protection

Protection against unsollicited messages: before you can submit your data, click the digits in the grid on the right to make the four digit verification code.

verification code:

Privacy: the data sent in this form will remain confidential; they will be used only for the purposes of accounting and the distribution of messages/documents that are deemed important to the members of the GAC-EPA.

* 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