جرج INTERNATIONAL UNION OF MACHINE BUILDERS
  
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83000, Donetsk,
street of Dzerzhinskogo, 1, 305
ph. +38 062 305-01-04
+38 062 301-08-05,
Work hours: from 9 to 17
On week-days



International Union        
of Machine Builders      
__________________
Building 6, room 305    
58, Artyom Street,       
Donetsk, 83001           
                       

Application Form


I, ________________________________________________________________________________

Name

_________________________________________________________________________________

born in 19___ , dwelling in ___________________________________________________________

_________________________________________________________________________________
Country, city

working at _________________________________________________________________________
company, institution

_________________________________________________________________________________
postal code, address, E-mail

__________________________________________________________________________________

__________________________________________________________________________________

express my consent to be a member of the International Union of Machine Builders

and represent the Union in ___________________________________________________________,
Country, city

inform on the decisions taken by it, assist to implement them, to attract companies,
organizations and natural persons to become the Union's members.

I am acquainted with the International Union of Machine Builders Statutes and agree with
its regulations.


      "___"____________ 20___ك.                                                      __________ / ______________/
Signature                           Name