Member Registration

 

Application form

 
I/we wish to receive invitations to lectures and activities of the following regional groups:
Basel BerneBienne – Solothurn Fribourg
Geneva Lausanne Zurich
 
Address for our members' register
Last name
If couple membership:  
First name of partner
Last name of partner
Institute / Company
   
Street / number
Code / City
Country, Area code
Email
Phone
Fax
   
Delivery address (if different from member address)
Mr./Mrs./Ms.
Last name
Institute / Company
Street / number
Code / City
Country, Area code
Email
Phone
Fax