first name
name
e-mail
phone
street
city
please choose
individual/family
membership
(CHF40)
collective
membership
(CHF100)
benefactors
amount chosen benefactor
payment
I
would
like
a
payment
slip
I
pay
via
internet
Trägerverein QTH, Betriebskonto, 8032 Zürich
PC 87-321322-1, Purpose of payment: 3010
submit