HOÄI
VAÊN NGHEÄ SÓ VIEÄT NAM TÖÏ DO
Association of Free Vietnamese Writers and Artists
E-mail:
vinhliem9@hotmail.com
ÑÔN
GIA NHAÄP
Soá Ñôn
G.N. _____________
Hoï vaø teân: _____________________________________ Thi hieäu, Buùt hieäu________________________________
Naêm sinh __________________ Nôi sinh _____________________________________________
Ñaõ hoaït ñoäng trong moät hoaëc nhieàu boä moân
Vaên Hoùa, Ngheä Thuaät: Thi [ ] Vaên [ ] Hoïa [ ]
Nhaïc [ ] Kòch [ ]
Ñieâu Khaéc [ ] Nhieáp AÛnh [ ] Ñieän AÛnh [ ] Phaùt
Thanh, [ ] Truyeàn Hình [ ] Baùo Chí [ ] Pheâ Bình [ ] v.v...)
______________________________________________________________________________________________
Ñòa chæ:
_________________________________________________________________________
________________________________________________________________________________________________
Ñieän thoaïi ___________________________ (nhaø)
_______________________________ (sôû/cell)
Fax _______________________________ E-mail ____________________________________________________
Toâi ñaõ ñoïc Baûn Ñieàu Leä vaø taùn ñoàng
Toân Chæ & Muïc Ñích cuûa Hoäi.
Yeâu caàu ghi teân toâi vaøo danh saùch Hoäi Vieân.
* Hai hoäi vieân giôùi thieäu:
1. ______________________________________________________________________________________________
2.
______________________________________________________________________________________________
Laøm taïi __________________________________
ngaøy __________ thaùng
__________ naêm _____________
Kyù teân
______________________________________