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2018申請「歌德館」人智學社群之會員
(請以中英文填寫)
First name 名字 *
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Surname 姓氏 *
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Street 街道(地址) *
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Postcode 郵遞區號(五碼) *
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City 城市(居住) *
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Country 國家 *
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Date of birth 出生日期 *
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Place of birth 出生地 *
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Phone (區碼)電話 *
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Fax 傳真
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Email 電子信箱 *
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Occupation 職業 *
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Comments 附註/說明
您若為歌德館舊會員,請填上(藍卡/粉紅卡)背面之會員編號:
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Membership Contribution 年費 *
繳費方式:一律現場繳費 (基本年費為NT$1500) 或其他金額,請自由填寫
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