Payment form for MJO Subscription & Annual Membership Fees

 

Please print this form and send to the fax: 90 312 235 4100 after submitting the membership form online. (Submitting credit card numbers through the internet may not be safe)

 

Payment for:

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CREDIT CARD AUTHORIZATION

 

I hereby permit for 50 (Fifty) Euros to be charged from my credit card for annual membership fee including the subscription to the Mediterranean Journal of Otology.

 

Charge my  ( )Visa   ( )Mastercard

 

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