To:

Hildegund Scholvien
Friedhofstraße 12
D-67693 Fischbach
Germany
Tel: +49-6305-993108
Fax +49-6305-5256
Email: hscholvien@cybernetica.de
Membership Application Form
for individuals and families

Name of organisation

Address for correspondence

Post code, City

Telephone

Fax

Email

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I/We apply for [ ] Individual membership (DM 40 per annum)

[ ] Family Membership (DM 50 per annum)

[ ] Life Membership (DM 425)

Subscription enclosed

Donation to EVU

For bank charges overseas postage etc

Total sum enclosed

 DM........................................

DM........................................

DM........................................

DM........................................

Date........................................... Signature...............................................................