Registration to become a member of the Microfluidics Association

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* 1. Member's details

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. VAT number ( your organization is not subject to VAT, fill in 0 )

VAT number

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* 3. Billing address is the same as above

Yes

No