Scientific Society Swakopmund

P.O.Box 361 Swakopmund Sam-Cohen-Library

info@swakopmund-museum.org.na Tel.: +264 64 402695

www.swakopmund-museum.org.na Fax: +264 64 400763

Museum

Tel/Fax +264 64 402046

(Print this page to complete the form)

Application for Membership

____________________________________________________________

Name

____________________________________________________________

Address

____________________________________________________________

Occupation Date of Birth

____________________________________________________________

Field of Interest

____________________________________________________________

____________________________________________________________

Tel.No. E-mail

____________________________________________________________

Date Signature

Annual Membership

( ) Ordinary N$ 92,00

( ) Family N$ 103,50

( ) Corporate N$ 138,00

( ) International 30,- €

Bank Details:

Standard Bank Namibia Ltd. Dresdner Bank, Düsseldorf

Branch: 082-172 Branch: 300 800 0

Accounto: 04 137 7230 Account: 211350802