Declaration of Admission  
Friend: Individual Supporter of the DAISY Consortium

Please type or print the information below and send by mail to: 
Mr. Bernhard D. Heinser
Chief Financial Officer, DAISY Consortium
c/o Swiss Library for the Blind and Visually Impaired
Grubenstrasse 12
CH - 8045 Zurich
Switzerland

Please send an electronic copy by email to: 
online-membership-notification (at) daisy.org


Your last name, first name:

			__________________________________ 
	
E-mail: 	__________________________________ 

Please give a brief description of your interest in DAISY, in English:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

Address:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Phone:   		__________________________________

Fax:  			__________________________________ 

Homepage:  		__________________________________ 
	
I hereby declare that I have taken cognisance of the Articles of Association of the DAISY Consortium and accept the Regulations relating to Friends of the DAISY Consortium in all respects. In particular I declare that our organization will do nothing that could be detrimental to the work of the DAISY Consortium.
 
 
Friend: Individual Supporter of the DAISY Consortium

Signed: 		__________________________________


(Name, typed) 	__________________________________


Date: 			_________