APPENDIX IV. 



87 



ENTRANCE FORM. 



The undersigned declares 

 his (or her) adherence to 

 the "Association of Friends 

 of the International Lan- 

 guage," as constituted by 

 the provisional statutes, 

 and subscribes 



for the year 19 



or in one t life member, 



payment ] protektanta 



as I membro. 



Signature . 



Christian name 

 and surname. 

 (Please write clearly.) 



Address. 



Profession or occupation 

 (optional). 



Natural language. 

 Age. 



Send this form tilled up, 

 together with your sub- 

 scription (international 

 money order), to the Secre- 

 tary of the Society, Herr 

 A. Waltisbuhl, 46, Bahn- 

 hofstrasse, Ziirich, Switz- 

 erland. 



UNIONO DI L'AMIKI DI LA LINGUO 



INTERNACIONA. 



ADHEBILO. 



Me subskribanta deklaras adherar a 1'Uniono di 

 1'Amiki di la Linguo Internaciona, tola quala 

 ol esa<i definita en la Provizora Statuti, e me 

 suskrijftas l 



r por la yaro 19 



unfoye ( permananta } , 

 [ quale \protektanta } membro ' 



Subskribo : 



Nomo e pretiom-o 



Adreso 



Profesiono (ne obliga indiko) 



Naturala lingua 

 Eco .. 



Sendez ta adberilo kun la suskripto (per inter- 

 uaciona valoro) a la secretary o-hasisto, So. 

 A. WALTISBUHL, 46, Bahnhofstrasse, Zurich 

 (Suiso). 



1 Minima suskripto : fr. 1'25, shilling 1, mark 1, 

 dollar 0-25. Permananta menibri pagas 50 fr. 

 unfoye ; protektanta menibri pagas 100 fr. unfoye. 



