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Ĉiu aliĝinto uzu apartan aliĝilon)
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Persona(j) nomo(j)
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Familia(j) nomo(j)
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Adreso (stratnomo, domnumero)
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Poŝtkodo, urbo
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Lando
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Naskiĝdato
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MM
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DD
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Retadreso
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Numero de poŝtelefono (kun land-prefikso)
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Libervola kontribuo al la Kongresa kaso (aldonu sumon):
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Noto:
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