Bli medlem Etternavn: _____________________________________________________________________________ Fornavn: ______________________________________________________________________________ Adresse: ______________________________________________________________________________ Telefon privat/jobb/mobil: _________________________________________________________________ E-mail adr.: ____________________________________________________________________________ Type medlem: Medlem: Fameilemedlem: Støttemedlem: (Sett kryss) Hvis din familie skal bli innmeldt som framiliemedlem, (anbefalt hvis 3 eller flere) så skriv resten av navnene under: _________________________________________________________________________________________ _________________________________________________________________________________________ Hvis du har andre bemerkelser, opplysninger o.l. så før disse inn under: _________________________________________________________________________________________ _________________________________________________________________________________________ ______________________________________________________________________________ |
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