 | * Pflichtfelder, information required |
 |
* |
| Name / Surname: * |
|
| Vorname / First name: * |
|
| Redaktion / Editorial office: * |
(max. 40 Zeichen, wenn keine, bitte "freier Journalist", Firmenname oder Institution eintragen)
(max. 40 characters, if none, please enter "free-lance journalist", company or institution) |
| Straße - Hausnr. / Street - Nr.: * |
-
|
| PLZ - Ort / Post code - Town: * |
-
|
| Land / Country: * |
|
| Telefon / Phone: * |
|
| Telefax / Fax: |
|
| E-Mail / email: * |
|
| Auto-Kennzeichen / Car reg. nr.: |
|