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100 Peter Thein Avenue
P. O. Box 157
Belgium, WI 53004-0157
Phone: 262-476-5086
Fax: 262-476-5087

 

 

Gift Membership

Gift Membership

Gift Membership Form

Membership Type
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Complete for Full-Time Student Membership Only
This is a Gift Membership FOR
This is the person RECEIVING the Gift Membership
(as you wish it to appear on Membership Card)
This is a Gift Membership FROM
This is the person GIVING the Gift Membership
(confirmation of this transaction will be sent to)
Send Gift Announcement To*
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Additional information
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Fernande Hastert Kuykendall Honorary Consul of Luxembourg in Arizona - luxconsulaz@gmail.com
Henry J. Leir Luxembourg Program