Tilmeldingsformlar

                                                                                                                            Club Danmark e.V.

                                                                                                                            c/oDänischesKonsulat  

                                                                                                                             Hohenzöllernring 72

                                                                                                                             50672 Köln

                                                                                                                             Tel: 0221-277 277 877

                                                                                                             E-mail:  info@clubdanmark.de

                                                                                                   Hjemmeside: www.clubdanmark.de

___ Ich/wir möchte(n) Mitglied werden als

        Einzelperson (€ 52)

        Familie           (€ 77)

        Paar                (€ 77)

___ Ich möchte Abonnent werden (€ 32)

                                                                            Ich zahle den Mithlieds-/Abobeitrag per Einzugsermächtigung

                                                                            Bank: ___________________________________

                                                                            BLZ:   ___________________________________

                                                                             Kontonr.:_________________________________

Vor- und Nachname:................................................................................

Strasse: ...................................................................................................

PLZ / Ort: .................................................................................................

Tel:         ...................................................................................................

E-Mail:    ...................................................................................................

____ Ich möchte nicht auf der Mitgliederliste aufgeführt werden.

Bei Familien bitte Name und Geburtsdatum der Kinder:

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Datum                                                                                           Unterschrift