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:
_________________________________________________________________________________________
_________________________________________________________________________________________ 
______________________________________________________________________________