Foreningens/Lagets navn: _______________________________________________________________________ Adresse: _______________________________________________________________________ Leder: ________________________ Tlf.: ____________ E-post: __________________ Kasserer: ______________________Tlf.: ____________ E-post: __________________ Lagets bankkontonummer: ___________________ Foreningens/Lagets formål: ________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Antall medlemmer under 18 år: _________ Over 18 år: _________ Kort beskrivelse av formål, virksomhet og arbeidsoppgaver: Eget møtelokale/hus/anlegg: _______________________________________________ Spesielle opplysninger: ____________________________________________________ _______________________________________________________________________ Dato: ____________________________ Underskrift ____________________________________ OBS! Skriv tydelig dersom du skriver for hånd. Postadresse Berg Sparebank Postboks 83, 1751 Halden e-post: [email protected]
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