Please check the items that apply and fill in the forms below:
Individual, non-profit institution, school/university or theater
group:
SFr 50 or $30 per year
Other group or collective member:
SFr 500 or $300 per year
Benefactors and sponsoring members:
SFr 5000 or $3000 per year
I/We hereby confirm that I/we support
the aims of the Max Ehrlich Association as laid
down in the statutes. As a member, I/we will receive regular
information on activities
and invitations to events.
Name
Title, profession
Organization or firm,etc.
Address
E-mail
Phone
We wish to pay our annual dues by:
Bank transfer
Banque Privée Edmond de Rothschild S.A.
Account No. 304.424
18, rue de Hesse
1204 Geneva, Switzerland
