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Mitgliedsnummer |
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I hereby apply for membership in the Verein für meckl. Familien-und Personengeschichte e.V. |
| 1. Personal Data: | |
| First name, Name 1: | ................................................................................... |
| Date and place of birth: | ................................................................................... |
| Occupation: | ................................................................................... |
| Address: | ................................................................................... |
| Phone: | ................................................................................... |
| FAX: | ................................................................................... |
| e-mail: | ................................................................................... |
| 2. Data for corporative member: | |
| Company name: | ................................................................................... |
| Contact person: | ................................................................................... |
| Address: | ................................................................................... |
| Phone: | ................................................................................... |
| FAX: | ................................................................................... |
| e-mail: | ................................................................................... |
| By signing this form, I accept the charter of the association. I accept that data on this formwill be stored in a membership file. |
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| Place, Date | Signature |
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Tag der Aufnahme |
Mitgliederdatei |
Schatzmeister |
Bemerkungen |