ANTIPROHIBITIONIST DAYS
Brussels-Luxembourg, 10-11 and 12 December 1997
* I will participate in both days of the meeting YES NO
* I will participate in the manifestation YES NO
of 12 December in Luxembourg
* I request you to reserve for me
- a room in a hotel YES NO
- a place in a youth hostel YES NO
* for the nights of:
- Wednesday evening YES NO
- Thursday evening YES NO
- Friday evening YES NO
* I will arrive on ... December around ... o'clock
* I will leave on ... December around ... o'clock
Please reply on the following fax numbers: +32-2-284.91.97 - 284.91.98 - 230.36.70 or via e-mail to Pr.bruxelles@agora.stm.it
Tel. +32-2-284.71.98
CORA/PAA: adhesion form
CORA-PAA (Radical Antiproibitionist Coordination - Parlamentarians for Antiproibitionist Action)
EUROPEAN CAMPAIGN FOR THE REVISION OF THE INTERNATIONAL CONVENTIONS ON DRUGS AND FOR THE REFORM OF THE POLICY ON DRUGS
I adhere to CORA-PAA - European campaign for the revision of the international conventions and for the reform of the policy on drugs.
YES - NO
(signature)
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Motivations (possibly)
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Name:
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Surmane:
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Address:
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City:
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Code:
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Country:
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Phone:
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Fax:
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E-mail:
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Profession
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Date of birth
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I enclose for the membership fee .................... USD
by:
- postal order addressed to CORA
- current account (ccp)
- Credit card ........................................
- number: ...............................................
- expiry date ......................................
MEMBERSHIP FEES OF CORA 1998 IN COUNTRIES OF EUROPEAN UNION
Austria 800 ATS, Belgium 2000 Bfr, Denmark 500 DKK, Finland 400 FIM, France 330 FF, Germany 100 DEM, Great Britain 35 GBP, Greece 5000 GRD, Ireland 20 IEP, Italy 100.000 LIT, Luxembourg 2000 Lfr, Netherlands 100 LG, Portugal 5000 PTE, Spain 5000 ESB, Switzerland 500 SFr.
BANK ACCOUNT
- no. 010381 registered in the name of CORA, Deutsche Bank (Abi 3002, Cab 03270), Italy
- no.10067.00101.1032083440/4 registered in the name of CORA, France
- no. 310107591981 registered in the name of CORA, Belgium
BANK ACCOUNT CCP: ONLY FOR ITALY
- c.c.p. 53362000 of CORA, Via di Torre Argentina 76, 00186 Roma
Please return to CORA-PAA: c/o European Parliament - Tel. +32-2-230.41.21 - 284.71.98 - Fax 230.36.70 - 284.91.98 - 284.91.97 -
E-mail: cora.belgique@agora.stm.it
