Membership Application / Antrag auf Mitgliedschaft

Date:

Membership:

New Member
Renewal

Membership Type:

Family
Single

Name:

First: MI: Last:

PCS or DEROS Date:

Other Adult Members:

* Only if a family membership.

Children Under 18:

APO Address:

Home Address:

Work/Unit Name:

Home Phone:

Work Phone:

Email Address:

Membership Dues:

$12 (or 12€) x (Members over 18) = $/€

Payment Type:

Please mail check (no cash) to one of the following addresses:

Postfach 101164
69001 Heidelberg

CMR 419 Box 1915
APO AE 09102

Or submit your you payment directly to:

H+G Bank Heidelberg
KTO: 60714401
BLZ: 672 901 00

Notes:

Heidelberg International Wandering Club