APOLLO 25 MEMBERSHIP

The membership is effective on a calendar basis (1st January-31st December of the current year).
To join A25, just print this form (prefered format is postcript), fill the blank, and send it by mail with your payment at the address of the association:

Association Apollo 25
21 Rue Claude Forbin (Appt. 152)
F - 31400 Toulouse
France

APOLLO 25 MEMBERSHIP SUBSCRIPTION FORM

First Name:............................... Last name:................................
Address:......................................................................................
...............................................................................................
Zip code:........................ City:................................................
State:.............................. Country:.........................................

Optional informations:

Age:.................... Profession:.....................................................
Telephone #:.................................. Fax #:......................................
E-mail:........................................

If you are a new member:

1. What are your principal centers of interest in the space exploration?
   
   
   
   
2. How have heard the existence of the association?
   
   
   
   
3. Do you agree to give your coordinates(address and/or E-mail) to the other A25 members? YES NO (tick the appropriate square)

I join the Association Apollo 25 for the year 1998, as (tick only one square!!):

active member, adult: 70FF
active member, student or under 18 years old: 30FF
active member, leaving out of France: 90FF
benefactor member: 140FF

I join my payment of ............FF, french bank cheque or International Money Order, payable to: "Association Apollo 25".

Date:.................................... Signature:......................................

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