Europe is you


Application Form



To the President
of the Executive Committee of the
Association of European Journalists-The Communication Network
Avenue Michel-Ange 68
B-1000 Bruxelles

I, the undersigned, ,
apply for membership to the "Association of European Journalists-The Communication Network".

Place and date of birth
Address: Work
Private
Street
Nr.
City/Town
Postal Code
Media: Newspaper
Television
Radio
Weekly Magazine
Monthly Magazine
Agency
Press office
Freelance
Online news
Others
Special professional interests:
Phone:
Mobile:
Email:
I authorise the use of my personal data listed above for the purposes of the Association of European Journalists – The Communication Network only.
Date

Signature (E-Mail)

Membership Fee: € 10,00 *
*Payment after acceptance of the application;
applicants will be informed.


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