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Membership Registration

Please use this form to register. Fill in all the required fields.

E-Mail

Write to us: henk AT e-velo-city.com

Phone/Fax


Phone: +41 76 346 8959

 

 
Personal Data:

Title*:
Dr. Mr. Mrs. Ms.

Last Name *

First Name *


Private E-Mail *


Home Address *

Sub Address

Postal Code *

Town/City *

Country *


Home Phone

Mobile Phone *

Nationality

Professional Data:

Job Title

University/Company


Work Address

Sub Address

Postal Code

Town/City

Country


Work E-Mail

Direct Phone
Your particular interests in the association



membership fees *
Please select as appropriate:
Membership fee CHF100.- Membership fee for students and retired persons CHF50.-*


* Please transfer the selected amount to the e-velo-city account at Banque Cantonale de Genève. Compte: L 3307.47.89 IBAN CH22 0078 8000 L330 7478 9


Any comments you have:
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