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INTERNATIONAL CULTURE SOCIETY Application form for membership SURNAME__________________________________________________________________ FIRSTNAME_________________________________________________________________ ADDRESS__________________________________________________________________ POSTNUMBER_______________________________________________________________ TELEPHONE Home____________________Work___________________Mobil______________________ E-MAIL_____________________________________________________________________ Please also answer next questions:: DATE OF BIRTH_____________________SEX: F □ M □ I REMOVED TO FINLAND_____________(year) PROFESSION___________________________ MOTHER TONGUE___________________NATIVE COUNTRY____________________________ I AM UNEMPLOYED □ Language skills______________________________________________________________ Do you have skills or hobbies or interests that can help MIRA? __________________________________________________________________________ You can write more about yourself on the other side of this paper All information is confidential. I accept that my name and address will be added to Mira's members register. PLACE AND TIME______________________________________________________________ SIGNATURE__________________________________________________________________