The Lavaux World Heritage Site Membership Application

The Lavaux World Heritage Site
Membership Application
Please typewrite or write clearly
Title
Mrs.
Mr.
Last Name
………………………………………………………………………………
First Name
………………………………………………………………………………
Address
………………………………………………………………………………
Zip / City
………………………………………………………………………………
Telephone
………………………………………………………………………………
E-mail
………………………………………………………………………………
Individual Member
Professional Member (Company or Institution)
Public Organization
CHF
CHF
CHF
50.-/year
150.-/year
2 500.-/year
I agree to be mentioned in some media of The Lavaux World Heritage Site.
Date
……………………..
Signature
…………………………………………………….
The Completed form should be forwarded to ;
Lavaux Patrimoine mondial
Place du Bourg 9
CH-1071 Chexbres
For more information : www.lavaux-unesco.ch
Lavaux Patrimoine mondial
Place du Bourg 9 | CH-1071 Chexbres | T. +41 21 946 15 74
www.lavaux-unesco.ch | www.patrimoinemondial.ch