support the museum - Museum Dr Guislain

Form

name *

address *

phone number *

e-mail *

Please don't fill in the field

Formula *

Student (15 euros)
Friend (25 euros)
Family (50 euros)
Supporting friend (min. 250 euros)

I have already been a friend before *

yes
no

I would like to get information and invitations.

by post
digital

Questions / remarks

5 + 7 = ? *