The BrainStorm fan questionnaire

Name and surname ____________________________________________

Date of birth __________________________________________________

Country ______________________________________________________

Address _____________________________________________________

Telephone number _____________________________________________

Where do you study/work? ______________________________________

Why do you want to become an official BrainStorm fan? ______________
____________________________________________________________

What would you want from BrainStorm fanclub? ____________________
____________________________________________________________

 

By signing this questionnaire I confirm that I like to become an official BrainStorm fan and enjoy all privileges which are given to me. I have no objection if my name and address would be included in the official Brainstorm fan register, which is sent to all official fans.

I am over 16 ___
I am not 16 ____

My parents have no objections about my joining the official BrainStorm fanclub and they confirm it with this signature:

 

____________________________________________
(Parents' signature is necessary only if you are not 16
years old yet)

Fan's signature: _____________________________

  

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