Membership form

Nirmiti Membership Application Form

Please fill in the following fields and click \"Formular Absenden\" to submit. All fields marked with asterisk require compulsory entries. If any of the mandatory fields are not applicable to you, please fill in NA and submit the form.

Applicant\'s Full Name *

Title *

Occupation *

Affiliation (Department/Institute/Industry) *

Nationality *

Address for Communication

Street, House number *

Postal Code, City *

Email *

Living in Goettingen since

How did you hear about us? *

If others, please mention

Any other relevant information

I, hereby, agree to register myself as a member of Nirmiti, association of Indians in Goettingen.

Mit dem Absenden dieses Formulars bestätigen Sie, dass Sie unsere Datenschutzerklärung gelesen haben und akzeptieren.

* Pflichtfeld

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