ASSOCIATION "ASTRONOMIA 21"
Str. Cutitul de Argint 5, RO-75212 Bucharest, Romania
Phone: +(401) 335 68 92; Phone/Fax: +(401) 337 33 89
E-mail: magda @ roastro.astro.ro
 

ENLISTMENT FORM
 

A. Name and Surname
     Address

B. Institute/Institution
     Professional Address

C. Field of Activity (essential data)
 

D. Form of collaboration taken into consideration within A21 (brief description)
 

E. I, the undersigned___________________________ ,
    commit myself to observe the Statute of the Association
    "ASTRONOMIA 21", to act in its interest, to respect its confidentiality,
    and to pay yearly the subscription.

    (Signature)

DATE:

     A 21 members recommending the acceptance
 

     The Council of the Association "ASTRONOMIA 21" approved on ___________________
     the enlistment of Ms./Mr.__________ as a Member of A 21.
               The annual subscription is of 10 USD.
 

PRESIDENT,

Dr. Magda Stavinschi