Membership application form Membership application form Personal Information Salutation MsMrMxnot specified Academic Title(s) preceded Academic Title(s) added Name * Name First name First name Last name Last name Adress * Adress Street name Street name Postal code Postal code City City Adress Country Email * Phone Gender femalemaledivers Date of Birth Association, Institution Website: Association, Institution Title of your Pikler® thesis (if already submitted) Membership Satzung der Europäischen Vereinigung für Ausbildung und Qualitätssicherung der Kleinkindpädagogik * I accept the statutes of the Pikler Verband Europa e.V. Application for membership in Pikler Association Europe e.V. as * full voting member (according to charter Article 4 (2 and 3)), annual fee (Minimum contribution 95,-)supporting member, annual fee (Minimum contribution 30,-)supporting organisation, annual fee Minimum (contribution 50,-) annual membership fee * annual membership fee * annual membership fee * Membership fee payment method Selection of payment method * Sepa direct debit Bank transfer SEPA direct debit mandate By signing this mandate form, you authorise Pikler Association Europe e.V. to send instructions to your bank to debit your account in accordance with the instructions from Pikler Association Europe e.V.. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Name of debtor * Name of debtor First Name First Name Last Name Last Name Credit institut (name) * BIC * IBAN * Signature * signature keyboard Clear Please transfer the membership fee to: PIKLER®- VERBAND EUROPA e.V. IBAN: DE51 7016 9450 0002 9215 45 BIC: GENODEF1ASG RAIFFEISEN VOLKSBANK EBERSBERG EG DE 85567 GRAFING BEI MÜNCHEN * I agree that this information may be stored in the organisation’s administrative system and not be passed on to any third party. The organisation’s charter was made accessible to me upon registration. I acknowledge and agree to abide by the organisation’s charter. Captcha Senden Falls Du menschlich bist, lasse dieses Feld leer.
