U.A.V. Membership

Do you want to become a menber of the U.A.V.? If so, we’ll need you to fill out the following form. The annual costs of an U.A.V. membership will be € 12,50.

! Attention: If you don’t want to share some of the fields in the form, simply fill in an ‘x’.

Personal Data

Initials

Name

Insertion

Surname

Do you wish to recieve our magazine, the PanGeo? Do you wish to recieve our magazine, the PanGeo? Yes No

Date of Birth (dd-mm-yyyy)

E-mail

Phone Number

Adress (Street + Number)

Zip Code

City

Country

Are you a Master Student? Are you a Master Student? Yes No

5 + 10 =