Personal Information

First Name:            
Surname:              
Date of Birth:             day/month/year
Nationality:*          
Address:               
                            
Postal/Zip Code:    
City:                     
Country:               
Telephone 1:         
Telephone 2:         
Fax:*                    
E-mail:                 
Education:*           
Profession:*          

* Optional

Membership

  Ordinary Member     22 €/year (200 SEK)
  Student*                  13 €/year (120 SEK)
  Active Member         220 €/year (2.000 SEK)
  Patron                     1.100 €/year or more (10.000 SEK)

* Student or members under 20 years of age

You will obtain a personal membership card as soon as your name is registered as a friend of Les Ballets Persans.

Payment

The membership fee should be sent to:

PlusGirot Bank
Account no: 339507-6
SWIFT code: PGSISESS
International Account Number (IBAN): SE59 9500 0099 6034 0339 5076
BIC: NDEASESS

Date of Payment:       day/month/year
Name of the Bank:  

Message: