Astronomy Club membership form

First Name *
Last Name *
Sex *
Birth Date *  Pick a date
Full Address *
Affiliated to Faculty of Sciences - Branch *
Job *
Phone number *
Email Address *
You are interested in /
How you'll contribute in *
Your theoretical knowledge level in astronomy *
Your practical knowledge level in astronomy *
Your interest level *
For how many years you practice astronomy? *
Are you a member of any astronomy club?
If yes, state the clubs
Do you own an instrument ?
If yes, state the instruments
Any Remarks or Suggestions ?

* required fields