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Registration form

To join our team please fill out the registration form and pay for a membership fee


    Applicant:
 * First name:
 * Surname:
Country:
 * City:
 * Zip/Postal code:
 * Street:
 * Home/apartment:
 * Date of Birth:
 * E-mail:
 * Phone number 1:
 
  Phone number 2:
 
I declare that I have read the terms of a club AS Ĉmielów and adopt them, while I agree to the use of my data for the Club and Porcelain Manufactory AS Ĉmielów (in accordance with the Act of 29.08.97 on the Protection of Personal Data, Journal. U. Nr 133 pos. 883).
Correspondence will be sent to the address given in the form!
I agree to the use of my personal data in accordance with the Law of. 29.08.1997 (OJ No. 133 pos. 883) for the Protection of Personal Data.
 * Code from picture:
    
* Demanded field



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