CZECHOSLOVAK SOCIETY OF ARTS AND SCIENCES (SVU)

APPLICATION FOR MEMBERSHIP

SVU membership may be granted to graduates of institutions of higher learning as well as other individuals who subscribe to and wish to support the aims of SVU. If both husband and wife wish to apply, they may fill out individual applications.

PERSONAL DATA Name____________________________________________________ Family Name First Name Middle Name Home Address_____________________________________________

Business Address__________________________________________

Telephone (Home)_________(Business)________Fax____________

e-Mail:__________________________ HomePage:_______________

Birth Place___________Birth Date: Day___Month___Year______

EDUCATION (start with the most recent) School Degree (Specialty) Year Use original degrees rather than foreign equivalents) __________________________________________________________ __________________________________________________________ __________________________________________________________

Other Training____________________________________________ __________________________________________________________

OCCUPATION Employer__________________________________________________

Position Title____________________________________________

Fields of Specialization/Competence ______________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

Main Publications and/or Other Accomplishments (you may attach CV) _________________________________________________________ _________________________________________________________ _________________________________________________________ Professional Societies___________________________________ _________________________________________________________ _________________________________________________________

Awards, Prizes, Other Recognition _________________________________________________________ _________________________________________________________

AIMS OF SVU

The Society, known by its acronym as SVU, is a cultural, nonpolitical, nonprofit and tax-exempt organization dedicated to the principles of search for truth, understanding among peoples, and free dissemination of ideas. The purpose of SVU is to bring together scientists, scholars, artists, writers, lawyers, businessmen, and others throughout the world who are interested in or pursue activities related to the Czechlands and/or Slovakia, their history, their peoples, and their cultural contributions.

I agree with the aims of the SVU and wish to become a member.

Signature______________________Date__________________

REFERENCES: Please list name(s) and addresses of SVU members who recommended you for membership. _________________________________________________________ DUES: $35; spouse: additional $5; student: $5; in Czech and slovak Republics: $10.

Send with your check to: M. Rechcigl, 1703 Mark Lane, Rockville, MD 20852, USA

Czech Info Center is not responsible for content of this public message. Please contact SVU with any questions.