APPLICATION FORM

Individual membership (122)

Individual membership

Membership: I would like to apply for individual membership.

Title:*

First name:*

Surname:*

Institution / company:

Street / No.:*

Postal code / town/city:*

Country:*

Telephone:

Fax:

E-Mail:*

Year of birth:*

Edition of Annual Review:*

Paperback

Hardback (surcharge CHF 20.- p/a)

Language of correspondence:*

German

French

Message:

Field « Security code » - please enter the result of the calculation.

Security code:

Don't fill this field!

SWISS ARCHAEOLOGY

Archaeologie Schweiz
Petersgraben 51
CH-4051 Basel
Tel +41(0)61 261 30 78
Fax +41(0)61 261 30 76
info(at)archaeologie-schweiz.ch
Mon to Thu 9am-12pm / 2pm-5pm