Name

Firstname

Adress

NPA

Place

Adresse e-mail

Do you have children Do you have children No Yes

Name, Firstname (child1)

Date of birth (child 1)

Name, Firstname (child2)

Date of birth (child 2)

Name, Firstname (child3)

Date of birth (child 3)

Subscription Subscription 1 person for a duration of one year: CHF 30.- Family contribution for a period of one year: CHF 60.- 33/5000 Donor member (minimum 30.-):

CHF

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