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Member
Registration
Application
form
Regular Member
(CHF 100.00 p.a.)
Students
(CHF 50.00 p.a.)
Couple Membership
(CHF 120.00 p.a.)
Donator
(CHF 500.00 p.a.)
I/we wish to receive invitations to lectures and activities of the following regional groups:
Basel
Berne
–
Bienne
– Solothurn
Fribourg
Geneva
Lausanne
Zurich
Address for our members' register
Mr./Mrs./Ms
Academic title
First
name
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.
Title
First
name
Last
name
Institute / Company
Street /
number
Code / City
Country
,
Area
code
Email
Phone
Fax
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