Supporting organisation

Username

Repeat email

My organisation wishes to support KVCV for 1 year.

Package

Gold: € 1500

Silver: € 1000

Bronze: € 500

These amounts do not include 21% VAT.

Contact person

Title

First name

Last name

Professional data

Function

Affiliation (company, institute)

Affiliation department

Address

Postal code

City

Country

Tel

Invoice data
Use the same data from above

Affiliation (optional)

Name

Department (optional)

Address

Postal code

City

Country

VAT number

Invoice

I want to receive an invoice from KVCV

My company will send an order first

If you choose to send an order first, please address this to :
KVCV vzw attn An Mammolito, p/a Universiteit Antwerpen, Campus Groenenborger, Departement Chemie, Groenenborgerlaan 171, 2020 Antwerpen
Or by email to info@kvcv.be

Remarks

Anti-spam

Supporting organisation

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