Membership Application Form Theresienstadt Martyrs Remembrance Association Please print this page, fill and send.
To:
Beit Theresienstadt,
Kibbutz Givat Haim Ihud
Emek Hefer 38935
Israel
From: . Last Name First Name
Address:
Street & Number City ZIP Code Country
My Membership request's reason [mark X]:
[ ] I was a prisoner in Ghetto Theresienstadt
[ ] Members of my family were among Ghetto's prisoner
(Parents / Grand-parents / Other)
[ ] Other reason:
Please send me the Newsletters in [mark X]:
[ ] Hebrew [ ] English [ ] Any other Associations's publication
If different to the address above, please indicate other mailing address:
Address:
Street & Number City ZIP Code Country
Enclosed a Cheque of USD for annual membership fees
(Single - 70 USD Couple - 100 USD)
I hereby request to join the "Theresienstadt Martyrs Remembrance Association" as an equal rights member, as described in the association's policies.
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