COMUNIDAD ISRAELITA DE ALICANTE
Please send the completed form to address shown below.
Por favour, retornar este formulario a la sguiente.
Membership Application Form. /Formulario para Nuevos Miembros.
(Please complete in CAPITALS) (Por favor, usa MAYUSCULOS)
NAME....................................................D of B./F DE N..../.../19.......
NOMBRE.
ADDRESS.
DIRECCION................................................................
. .........................................................................
.........................................................................
HOME ADDRESS..............................................................
(Non-residents)...........................................................
. ..........................................................................
E.MAIL ADDRESS:...........................................................
TELEPHONE No/No de TELEFONO:.....................Mobile./Movil:................
(Tick as appropriate)...(Marcar el apropiado:)
I wish to apply for membership of the Comunidad Israelita de Alicante and I enclose my Annual Subscription of:
Family Membership: 250 euros. Individual Membership: 150 euros.
Solicito el ingreso como miembro en la Comunidad Israelita de Alicante, e incluyo mi suscription de:
Familiar: 250 euros. Individuales: 150 euros.
(Note: Annual subscriptions are renewable from 1st January each year) (Nota: El abono esta renovable de 1 Enero cada ano)
Signature (Firma)___________________________Date (Fecha)_________
Please indicate below which of the following activities are of interest to you.
- Music appreciation (Musica)
- Theatre visits (Visitas al teatro)
- Talks (Charlas)*
- Day Trips by car or coach (Salidas de un dÃa por coche o autobus)
- Trips of 3-4 days to places of interest (Salidas de interes 3-4 dÃas)
- Other (Indicate. / detalla)
Please return this form to :
Mr Manny Kleyman, Buzon 176, Ctra Cabo La Nao (pla), 124-6, 03730, Javea, Alicante.
Membership Form (I)(S).doc Jan 07.rev.oct07 bi
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