Wissenschaftliche Gesellschaft Swakopmund

 

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

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

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

 

                                                                                                          Museum

                                                                                  Tel/Fax +264 64 402046

(Diese Seite ausdrucken und einfüllen)

                                  

Mitgliedsantrag

 

 

____________________________________________________________

Name

 

____________________________________________________________

Adresse

 

____________________________________________________________

Beruf                                                                          Geburtsdatum

 

____________________________________________________________

Interessengebiete

 

____________________________________________________________

 

 

____________________________________________________________

Telefon                                                                       E-mail

 

____________________________________________________________

Datum                                                                        Unterschrift

 

                                  

                                   Jährlicher Beitrag

 

                                   (   )      Einzel                           N$   92,00

                                   (   )      Familien                       N$ 103,50

                                   (   )      Firmen                         N$ 138,00

                                   (   )      Ausland                       30,- €

 

Bankverbindung:

Standard Bank Namibia Ltd.                                    Dresdner Bank, Düsseldorf

BLZ: 082-172                                                                           BLZ: 300 800 0

Konto: 04 137 7230                                                               Konto: 211350802