420PEOPLE CLUB APPLICATION FORM

Upon the receipt of your application form and of the payment, we will in return provide you with the number and confirm your membership via mail (

Name:
Address:
Telephone:
E-mail:

Membership type:

Friend (> 420 CZK)
Sponsor (> 4200 CZK)
Benefactor (> 10420 CZK)
Solo (a made-to-measure support)

Method of payment:

Payment can be made by cash at the KLUB desk before the performance or by bank transfer (in the latter case please fill your bank account number in the application).

Cash
Bank transfer

Account No.:
Bank:

Our membership account:

Name of account: 420PEOPLE
Komerční banka : 43-6061050287/ 0100
IBAN: CZ8901000000436061050287
SWIFT: KOMBCZPPXXX

We will very much appreciate if you find a few minutes to fill in the following additional information…

How did you learn about the club:

Press advertisement
E-mail / web
Flyer
From a friend
Other

Please specify

Your age:
Your profession:

Do you want to receive news from the company in your e-mail?
yes no

Info: 420PEOPLE o.s., Hvězdova 35, 140 00 Praha 4, IČO: 22833731, Registrace: MVCR, 1.10.2009 pod číslem VS/1-1/77023/09-R