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Jewish Material Claims
against Germany - 1999

 
Home >> Support us >> Membership Form
 

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.

                                                                                                                                                 

                Date                                                                                      Signature

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