The Irish Czech and Slovak Society
MEMBERSHIP FORM
I wish to join the Irish Czech and Slovak Society:
__
I wish to renew my membership:
__
(Please, check box as appropriate!)
Name:
Address:
Tel.:
Fax.:
E-mail:
Interests:
Membership category
Individual: €15
Family: €25
Student: €10
Corporate: €60
Corporate (NGO): €10
Retired: €10
(Please, mark as appropriate!)
Send to the Treasurer:
Jindrich Dolezal
Silicon & Software Systems
South County Business Park
Leopardstown
Dublin 18