Application form*

Family Name   Forename   Profession / Title     Institution   Street   Town / Postal Code     Country   Phone   Fax   Email   Place, Date   Signature

* Please, print it out, complete in capital letters and send it signed to the Corresponding Secretary of your national branch. If there is none, send it to the Secretary/Treasurer of WVPA:

Dr. Francois-Xavier Le Gros
Merial, Lyon Gerland Laboratory
254 rue Marcel Mérieux, BP 39I
69007 Lyon
France