Membership Application

Please fill out the following form and send.

Name: Nickname:
Email:
Street
City/Zip
Telephone
Fax
Handy
Birthdate Day:  Month: Year:
Partner Nickname:
Birthdate Day:  Month: Year:
Child 1 Nickname:
Birthdate Day:  Month: Year:
Child 2 Nickname:
Birthdate Day:  Month: Year:
Child 3 Nickname:
Birthdate Day:  Month: Year:
Payment via: Ka mag-anak Account: 910465, BLZ: 79561348
Automatic Withdrawal Only when <Automatic Withdrawal> has been selected
Account nmber
Bankleitzahl
Name of Bank
Account Owner
Your Message

 

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