LiLux - Member Registration

Please fill out ALL the fields (Informations are not published).

Don't forget to add a VALID e-mail address where we may contact you.

The membership fee is 15 EUR that should be transfered to our CCPL account:
IBAN LU43 1111 1555 5564 0000 to the order of:

   Lilux a.s.b.l.
   7, rue Jacques Sturm
   L-2556 Luxembourg

The nickname should be at least 3 characters long and maximum 8.
If you have an account on the prophecy server please use the same nickname as your login name. Please mark the nickname into the comment field of your bank transfer, so that we can match your payment to your registration more easily.

Nickname (8 characters maximum) :
First Name :
Last Name :

Address (Street and Number) :
Address (City and Postal Code) :
Address (Country) :
Daytime phone :
Evening phone :
Fax number :

Birthdate :	Yearmonth day
E-mail address :
Your WEB-page :

Please add any comments here :

Agenda

LiLux - Member Registration

Don't forget to add a VALID e-mail address where we may contact you.

The membership fee is 15 EUR that should be transfered to our CCPL account: IBAN LU43 1111 1555 5564 0000 to the order of:

The membership fee is 15 EUR that should be transfered to our CCPL account:
IBAN LU43 1111 1555 5564 0000 to the order of: