INCTR at the Institut Pasteur
Rue Engeland 642
B 1180 Brussels, Belgium
ph: 32-(0)2-373-9323
fax: 32-(0)2-373-9313

The International Network for Cancer Treatment and Research is a not-for-profit organization dedicated to helping build capacity for cancer research and treatment in developing countries. The goals of the INCTR are to lessen the suffering, limit the number of lives lost, and promote the highest quality of life for children and adults with cancer in these countries. Through these efforts, it is hoped that the quantity and quality of cancer research will be increased throughout the world.

We would like to invite your organization to become an Associate Member of the INCTR.

________YES, Our organization would like to become an Associate Member of the International Network for Cancer Treatment and Research

PRINT THIS FORM AND MAIL OR FAX TO THE ADDRESS ABOVE

Associate Member Information

Name:

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Company/Institution Name:

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Department/Division:

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Address:

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Telephone:

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Fax:

________________________________________________________

E-mail address:

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For information about membership fees, please contact Elisabeth Dupont:

Tel: 32-2-373-9323 or Fax: 32-2-373-9313.