Application Form

Membership in INTERKULTUR Foundation

I am/we are interested in becoming a member/members of the INTERKULTUR Foundation

Please send me/us detailed information on the membership. In case you are already a member, please fill in your membership number below.

(Please do not use vowel mutations or special characters when filling in this form!)
Name:*
Membership-no. (if available):
Language:
Form of address:*	Mr. Mrs.
Surname of the contact person:*
First name:*
Street:*
Zip code:*
City:*
Country:*
Phone:
Fax:
E-Mail:
Remarks:

	* = obligatory entries