Application for Membership

Please print out the form, fill it out and snail-mail it to us together with the admission due and your voluntary membership contribution

Name, Surname:	_________________________________________________________
Street:	_________________________________________________________
Country, ZIP, Town:	_________________________________________________________
Phone, Fax, E-Mail:	_________________________________________________________
Birthdate:	_________________________________________________________
Profession:	_________________________________________________________

I herewith want to apply for supporting membership in the Freie Zone e.V..

I fix my membership contribution to __EUR/__$ ________ /year

The admission fee (20 EUR / 20 $) (see: Regulation of Membership Dues) and my first membership contribution

___ I attached a check (or cash) to this application sheet.

Voluntary data:

In what field would you be able to help us?

________________________________________________________________________________

Since when in the Free Zone? ____________________________________________________

How did you learn about the Freie Zone e.V.?

________________________________________________________________________________

Legal regulation for protection of data (according to German law):

I authorize the Freie Zone e.V. to store the data related to my membership application as far as it is necessary to establish proper relations with the association and as far as it enables the association to take care for the affiliation.

Place, Date _____________________________

Signature _____________________________

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