Required *

Personal information

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I hereby declare,

Surname *

First name*

Birthday *

Street, house number *

ZIP, City *

Email *

Phone/Mobile *

Fax

Bitte lasse dieses Feld leer.

Job

my membership in the Vogelburg-Club.

Membership fee

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I am willing to make an annual contribution * of

Annual fee *
€ 25,-- (individual)€ 50,-- (family ticket)€ 75,--€ 100,--Other amount

to pay.
The contribution is paid once a year by direct debit.

Authorization to collect contributions

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I hereby revocably authorize you to collect the annual membership fee to be paid by me from my account specified below by direct debit.
Banking institution name *

Account number *

Bank code *

Account holder name *

IBAN *

BIC *

The move-in should take place for the first time on *

If the specified account does not have the required funds at the time of collection, the bank holding the account is not obliged to redeem it.