Membership Application Form

Title:
Initials:
Surname:
Gender / Date of Birth:	Male / Female
Address:
Postal Code:
Residence:
Country / Language:	Choice Australia Belgium Brasil members Arge brasilien Brazil Bulletins Chile. Columbia France Germany Netherlands Switserland Thailand United Kingdom United States.	Choice Dutch English German
Phone no. / Cell:
E-mail:
Preferred Login Name (6-8 characters):
Password (6-8 characters):
Password check:
Start Membership:
Bank Account:
BIC:
IBAN:
Type of Membership:	Choice Member Internet Member Aspiring member Member of Arge Brasilien Member USCA member latein America Supporter
Special Details:
Introduction:
Philatelic Supplies:	YES	NO
Meetings:	YES	NO
Convocations:	YES	NO
Donation Amount:	euro