Membership Application - Information Name: Sex: Male Female Address: Telephone: Mobile: Email: Nationality: Occupation: Interests: Spouse/Partner - Information Name: Telephone: Mobile: Email: Nationality: Occupation: Interests: Children - Information Name Date of Birth M/F Membership - Information MABL 2013 Annual Subscription Rates Student: €18 Individual: €28 Family: €38 Membership Subscription Type: ---Student (€18)Individual (€28)Family (€38) Payment by: ---BanktransferCash If paying by Bank Transfer, please write “ MEMBERSHIP – THE YEAR – YOUR NAME ” Allow personal data to be published on Members Directory Yes No