Observatory for Social and Economic Development in the Basque Country
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About Gaindegia
The Observatory
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Aims for 2007
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Order form
Please complete the following order form:
Identification
Full name
*
:
EHNA or other identity card number:
Date of birth:
yyyy/mm/dd
Contact information
Street number, street name and apartment number:
City:
Zip code:
Province or state:
Phone number:
Alternative phone number:
E-mail address
*
:
Alternative e-mail address:
Instructions
What language would you prefer to receive materials in?
*
:
Basque
French
Spanish
How would you like to receive materials?:
By e-mail
By regular mail
Membership
Type of membership
*
:
Regular member (100 € per year)
Supporting member
Benevolent member (benevolent members will be corporations and they will decide how they wish to contribute financially)
Form of payment:
600 € per year
Five year´s dues paid in advance
We will contact you to request bank details needed to effect payment
Other
Occupation:
Business owner
Professional
Journalist
Union member
Academic
Other
Educational background:
Pre-university
University degree
Doctorate
Profession:
Company/place of work:
What languages do you speak?:
GAINDEGIA.
943 30 43 65 Tel./Fax. -
Posta-e.
Martin Ugalde Kultur Parkea. Gudarien Etorbidea 8, 20140 Andoain