Speciaalclub Aziatische
Vechthoenrassen
Sonderverein Asiatische Kampfhuhnrassen
The Asian Gamefowl Society
FOMEMBERSHIPFORM (please print out)
YEAR (...............................)
Please
fill in all fields as we use these data to be published in our
membershiplist
for communication purposes. If you require extra privacy then
please tick the boxes
in front of each data section. Name, Country, Telephone/Mobile and Breeds are
mandatory !!! The rest of your personal data is only used for
postal usage. The
form must be filled in each year. This to ensure the most update
information.
Thanks in advance for your coorperation.
O Name
O Address
O City
O Postal Code
O Country
O Telephone / Mobile
O Fax
O
Email
O Breeds (large)
O
Breeds (bantam)
Date
Signature
Clubfee
United Kingdom 10,- POUNDS
European Continent 15,- EURO
America/Asia/Africa
USD 20,-
Attention
: we cannot accept personal cheques
anymore as we must pay a large fee to cash these. Please forward
your money as cash wrapped in your membershipform (if necesarry
as -registered- mail).
Receiver Wilhelmus van Ballekom
Other payment options :
Western Union or Money Gram money transfer : please use the following receiver data (ONLY ELECTRONIC TRANSFER - NO CHEQUE)
Wilhelmus van Ballekom - 18 / 11/ 1959 - Hobokenlaan 19 - 5628 VA - Eindhoven - Holland
Members living in the European EURO zone can send their fee without any charge to our European account nr
using IBAN en BIC numbers (see below) IBAN NL42 FTSB 0949 6693 69 and BIC FTSBNL2R
(normally both numbers are required).
AGS
Secretary
Willem van Ballekom
Hobokenlaan 19 - 5628 VA Eindhoven - Holland
tel (+31) - 40 - 2417208 please watch time zones
fax (+31) - 84 - 7366269