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: