MEMBERSHIP FORM

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MEMBERSHIP FORM

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I want to receive e-mail notifications about the current program and invitations ... for marketing purposes, especially

MEMBERSHIP FORM

Friends of POLIN Museum of the History of Polish Jews NAME AND SURNAME: ................................................................................................ ADDRESS: (street) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (postal code, town/city)

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(country) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TELEPHONE NO.: ................................................................................................ E-MAIL: ................................................................................................ CHOOSE YOUR CARD: Alef

Bet

Gimel

Dalet

I want to receive e-mail notifications about the current program and invitations to events organized by POLIN Museum: Yes

No

I already receive notifications

I hereby give consent for my personal data included in the membership form to be processed for marketing purposes, especially as related to the program of POLIN Museum of the History of Polish Jews, with its headquarters at 6 Anielewicza Street, 00-157 Warsaw, in accordance with the Personal Data Protection Act of 29 August 1997 (Journal of Laws of the Republic of Poland 2002 No. 101, item 926 with further amendments).

.......................................................... Date/Signature