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         Wolfplex hackerspace ASBL - membership form
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0. Introduction
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This form is for hackerspace members.


I. Identity
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Firstnames (*) .......
Lastname .............

Address .............. 
Postal code / city ... 
Country ..............

Birth date ...........
Birth place ..........
Nationality ..........

(*) Please write all your firstnames.


II. Community implication
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Check one or both of the boxes.

[ ] I wish to be an hackerspace member

[ ] I wish to be a Wolfplex hackerspace ASBL's 'adhérent' member


III. To fill by the legal guardian if you're minor
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I, ________________________________, as the minor identified in section I's
legal guardian, allows him/her to join Wolfplex hackerspace ASBL as member
(effectif or adhérent) and, if applicable, to sit at Conseil d'Administration.


(date and signature)






IV. Wolfplex account creation
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All the membership information is managed by the Wolfplex intranet.

This intranet could be also reached as members spaces on our site:
http://www.wolfplex.org/members/

Please state the login you wish and a valid mail address.

Login ................ 
E-mail ...............