Membership application


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Name

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First Name

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Street address

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Town, Postal Code

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Country (in Germany: Bundesland)

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Phone (optional)

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Fax (optional)

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Email

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Home page (optional)

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Date of birth, Nationality

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Occupation (optional)

I - agree - do not agree - * that my address be disclosed to other members on request.

* Please delete as appropriate.

Please accept me as a member of the International League of the Non-religious and Atheists, registered association (German: Internationaler Bund der Konfessionslosen und Atheisten e.V.)

  • Full member *
    I expressly declare that I am not a member of any church, denomination or religious community.
  • Extraordinary member *,**
    I expressly declare that due to professional or social reasons, I am a member of a church, denomination or religious community against my convictions.

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Place, date

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Signed

Application for reduced contribution

  • My spouse/partner

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    is a full member or is applying for membership at the same time as myself. *
    We receive only one copy of each the Rundbrief and the MIZ.
  • I am a member of

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  • I am on low income.*,***

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    _____________________________________


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Signed

* Please mark with a cross where applicable.
** With restricted access to official functions.
*** Please explain briefly.

Please fill in this form and send it to: IBKA e.V. Mitgliederverwaltung, c/o Rainer Ponitka, Limburger Str. 55, 53919 Weilerswist, Germany