GOTLANDS GILLE
                      i Gφteborg                                Inkom / 200..

c/o sekr Ann-Mari Stahre
                Salviagatan 2                                                                            Intrδdesεr ……
               424 40 Angered
               Tel: 031-53 29 33
               e-post: rune.ann-mari@swipnet.se

                                         A N S Φ K A N

Undertecknad φnskar anmδla mig/oss som medlem i Gotlands Gille i Gφteborg.

 

Namn: -------------------------------------------- ---------------------------------------

Adress: …………………………………… …………………………………….

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Ev. e-post-adress: ………………………………………………..

Telefonnr: ………………… ………………. Personnr: ……………… ……………………

 

Fφdelseort pε Gotland: ……………………… ………………………………….

Nuvarande Gotlandsanknytning (om annan): ……………… ……………….

Gφteborg den    /      20……..

 

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