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Se PDF versjon her - LHL

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✂JA, JEG VIL BLI MEDLEM I <strong>LHL</strong>Hovedmedlem (kr 300,- pr år) Husstandsmedlem (150,- pr år)Navn: ............................................................................................................................................................................Adresse: .......................................................................................................................................................................Postnr/-sted: ................................................................................................................................................................Telefon: ............................................................ Mobil: .................................... Fødselsdato: ................................E-post: ..........................................................................................................................................................................Ja, jeg vil motta informasjon fra <strong>LHL</strong> på e-postInteressekategori: Hjerte Lunge Pårørende Annet ...................................................Ved innmelding av husstandsmedlem må navn på hovedmedlem også fylles ut.Navn hovedmedlem: ..................................................................................................................................................................................Ververs medlemsnr.: ...................................... Ververs navn: ..................................................................................................................Ververs adresse: ...........................................................................................................................................................................................Postnr/-sted: .................................................................................................................................................................................................

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