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The International José Cura ConneXion

Application for Membership

Please fill in the form completely.

Title:  Mrs.    Mr.

Name:

Surname:

Street and number:

City and Postcode:

Country:

E-Mail:

Telephone:

IŽd like to get the
(Broadsheet) in:  English    German

I would like photos:  by e-mail    by post    No

May we give your details to
other members       Yes     No


Payment will be in:  Pound    Euro  

Membership-fee ist 10 Pounds or 10 Euros. Please sent the subscription in cash to
Marlene (10 GBPounds) or Sandra (10 Euros). The adress for this will be sent to you
by e-mail when we receive your application form.
The International José Cura Connexion doesnŽt guarantee for money lost by mail.
Therefore we recommend cash be sent by registered post.