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If you wish to join the Kippenheim Synagogue Patrons Society, just print out this form, fill it out and send it to the address printed below. Thank you very much!
Send to:
Förderverein Ehemalige Synagoge Kippenheim
Postfach 0190
D-77968 Kippenheim
BRD/ Germany
Tel. +49 (0) 7822-896254
Fax. +49 (0) 7822-30275
E-mail: buero@ehemalige-synagoge-kippenheim.de
Membership Form
I wish to join the Kippenheim Synagogue Patron Society as (please tick the appropriate circle)
O Single person (annual membership fee 20 Euros)
O Married couple or family (annual membership fee 25 Euros)
O Organization (annual membership fee 40 Euros)
Name:.............................................................................................
Street Address:................................................................................
Postal code, city or town:.................................................................
Country:...........................................................................................
Phone #:...........................................................................................
e-mail:..............................................................................................
Date:................................................................................................
Signature:.........................................................................................
All information will be kept confidential and will not be passed on to other organizations without the written permission of our members.
Residents within the European Union should remit their fees in Euros by check or by elec-tronic fund transfer to IBAN DE09 6645 0050 0076 1093 99, at the Sparkasse Offenburg/ Ortenau, SWIFT-BIC: SOLADES1OFG
Residents outside the European Union please contact us personally for payment.
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Kippenheim Synagogue Patrons Society,
a non-profit organization