Verein „Antikes Antiochia“ e.V.
Cuvrystr. 34

10997 Berlin

The association "Antikes Antiochia e.V." is exclusive and directly non-profit purposes serving for " by certificate of tax office as recognition.

I would like to join __________ the association " Antikes Antiochia" off as a member.

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Surname/Company                                                                            Name

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Street/ Nr. Postal                                                                     Code/ Place

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Occupation                                                 Date of Birth (Indicationreleased)

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Tel. (During theday)                                                                              Fax

The height of the annual contribution,however not less than EUR 30.00 for extraordinary member and EUR 240.00 for a regular,intend name/company first name enfranchised member.

My membership dues amount to EUR __________ per calendar year.

Membership dues are paid for the first time by me to__________ and in the future in the January of each year.

I give e.V.an account direct debit authorization to the association " Antikes Antiochia". Thus due contributions up to revocation are deducted directly by my account.

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Bank account                                                                 Bank code number

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Account number                                                           Owner of an account

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Date,Signature