PRISTUPNICA ZA LANSTVO

MEMBERSHIP APPLICATION FORM

Ime i prezime Spol

Name and surname Sex
M /F
Djevojako prezime
Maiden name
Datum roenja 01.06.1994. JMBG 0106994120037
Date of birth Only for Ex-YU citizens
Mjesto i zemlja roenja ,
City and state of birth
Adresa prebivalita , , 74000
Address of residence
Broj telefona 0038765348929
Phone number
Elektronska pota bojan.ognjen@gmail.com
E-mail
Obrazovanje i zanimanje
Occupation and profession
Radno isustvo
Working experience
Hobi, vjetine i znanja
Hobbies, skills and competences
Strani jezici
Foreign languages
Potomak registrovane rtve / Descendant of registered victim Srodstvo Potovaoc
Prezime (oevo ime) ime rtve / Surname (Fathers Name) Name sa rtvom (Supporter)
Razlog pristupa Udruenju
(Relationship
(Potomak/potovaoc rtava)
with victim)
Reason for application
(Descendant/Supporter of Potomak neregistrovane rtve / Descendant of non registered victim
Victims) Popunite formular na ovom linku / Please fill form on this link
Link za unos zrtava / Insert data for new victim

Prihvatam Statut, te prava i dunosti lana Udruenja potomaka i potovalaca kompleksa ustakih logora Jadovno 1941. I accept the
Statute and the rights and obligations of membership of the Associations of Descendants and Supporters of Victims of Ustashian
Concentration Camps in Jadovno 1941.
Mjesto i datum/Date and place: Potpis/Signature:

Napomena/Note:

Adresa: Kralja Alfonsa XIII 49A, 78000 Banja Luka, Republika Srpska, Bosna i Hercegovina
Tel.: +387 51 333 588 | Faks: +387 51 333589 | email.: Udruzenje@Jadovno.com | www.Jadovno.com