Lanz Bulldog Verein West e.V.


Membership application form

Yes, I want to become a member of the club.

name
first name
Street
ZIP code
City
Country
Telephone
Fax
Profession
Email
Date of birth
Adult (26 EURO/Year)
Pensioner (18 EURO/Year)
student (18 EURO/Year)
family (40 EURO/Year)

Paymode

I will send the money within one week by euro cheque or international money order
to the following adress:
Lanz-Bulldog-Verein "West" e.V., Vorstadt 23, D-41812 Erkelenz/Germany

Yes, I am human and not a SPAM machine.

Please fill in the code.


© Copyright Theo Scheres, Wegberg/Germany