REGISTRATION FORM

Please complete and sign this form and return  to Treasurer NSfJG, P.O. Box 94703, 1090 GS Amsterdam, The Netherlands

Name:                         ……………………………………………………………………………………………………...

c Male                    c Female

Address:                        ……………………………………………………………………………………………………...

City:                               ……………………………………………………………………………………………………...

Zip code:                       ……………………………………………………………………………………………………...

Province:                       ……………………………………………………………………………………………………...

Country:                           ……………………………………………………………………………………………………...

Phone:                            …………………………………………………(Fax)       ………………………………………...

E-mail:                      ……………………………………………………………………………………………………...
 

Hoe hebt u de vereniging gevonden:

[ ]Link op het internet;      [ ]de folder;      [ ] via een archief;    [ ]via een andere genealoog;   [ ]op een andere manier.....................

I would like to become a member of the Netherlands Society for Jewish Genealogy

c   Until further notice I authorize the NSfJG to charge the annual membership fee ( 30 Euro) to the following account

c         Dutch bank account no cccccccccc

c Mastercard/Eurocard              c Visa             c American Express

Card no              cccc  cccc  cccc cccc

For Master/Eurocard and Visa the last three digits on the signature strip at the back of the card    ccc

Valid until     cc / cc

Name as printed on card ………………………………………………………..

For credit card payments a 10% surcharge applies

c    I enclose a check for USD 50.00

Date: ……………...………….               Signature: ……………………………………………