Heves megyei aprónyomtatványok 17/G

APPLICATION CARD

/to be filled in with typed or blocked letters/

/male - female/ x

Profession:

Address:

country

town

street and number

I announce that I would like to take part in the monument section of Eger Summer Course.

I note that the course fee is ..... Ft.

I shall transfer the course fee to the account of the County Organ of TIT No. 350-90171-9092 or I shall pay on the premises. x

Please ensure RUSSIAN, GERMAN, ENGLISH, or FRENCh interpretation. x

x /Please underline the proper part./

signature