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I  herewith apply for Membership in the "European Association for Astronomy Education" EAAE, according to the EAAE Statutes and By-laws.

Name, Affiliation ..

Date of birth

Sex .

Occupation ..

Address: Street:

Postal code, City ..

Country: .

Phone:

Fax: ..

E-Mail

Type of membership:

Ordinary member (individual)

Ordinary member (Institution).we enclose documents about works and aims of institution

Sponsoring member

Special interest in Astronomy:

special interest in the EAAE

Place, date: Signature:

 

 

For individual only:

My member ship is recommended by:

Name, affiliation

Address

Place ,date Signature

 

Name, affiliation

Address

 

Place ,date Signature

 

Inviare il modulo compilato per posta ordinaria alla rappresentante nazionale:

Cristina Palici di Suni

Via Giulia di Barolo 3

10124 Torino