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Online services - Form for donations to ITM

Donate by credit card

To support the activities of the Institute of Tropical Medicine via online payment, fill out the form below. 
This online payment system accepts American Express, Eurocard/MasterCard en VISA.

Name *
First name *
Company
Address *
Postal code *
City *
Country *
Phone number *
Fax number
E-mail address *
VAT number
Amount (EUR)*
Purpose
 
 
 

Donate by Paypal


Donate by bank transfer

Belgian account number: BE38 2200 5311 1172 (Fortis Bank, Warandeberg 3, 1000 Brussel)
BIC/SWIFT: GEBABEBB

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