I declare one’s readiness to be a real / candidate (choose one of the options) member of the Polish Society of Double Bassists and I commit of respecting the rules recorded in the charter

surname & forename:.......................................................................................

date & place of birth:........................................................................................

nationality:......................................................................................................

sex:...............................................................................................................

address (country / post city code / town / street):..................................................

.....................................................................................................................

e-mail:...........................................................................................................

telephone number:............................................................................................

current job position (for the students - school name / teacher’s name / year of studies):

......................................................................................................................

......................................................................................................................

date & signature:..............................................................................................

The membership starts after sending the declaration and the copy of the payment – entrance fee 10 Euro and member fee 30 Euro per year (students have 50% concession) to the following account number:

Polskie Stowarzyszenie Kontrabasistow we Wroclawiu
DOMINET BANK Lubin, Poland
SWIFT: CUPR PL P2 IBAN: PL 54 1690 0013 2039 7305 5534 0001