Priezvisko:__________________________________________________________
Adresa:_____________________________________________________________
Tel:_____________________________ Email______________________________
Dalsi clenovia rodiny:
Meno a priezvisko manzela (ky) _______________________
Meno a priezvisko deti_______________________________
__________________________________________________
Rad, rada, radi by sme Vam pomahali v tejto oblasti ________________________
Podpis _______________________________ Datum ___________________
Vyplnte prosim prihlasku a poslite so svojim sekom na adresu:
| Czech and Slovak Association, Inc. | Jednotlivci : $20.00 |
| P.O.Box 9 | Rodiny: $30.00 |
| Boston, MA 02128 | Studenti a dochodcovia (65+) : $10.00 |
| Dobrovolne dotacie: | |
| Celkom posielam: |