SuMa-eV membership application

I hereby declare,

for the company:

Function:

Address:

EMail-Address:

Web-Adress/URL of Homepage:

Phone:

that the I - want to join "SuMa-eV - association for free access to knowledge." I have taken note of the statute and agree with the objectives of the association. The minimum fee for individual members and private individuals, 5,-EUR per month, students half; for companies, institutions and mechanisms 5, - EUR per month and employees at companies with more than 20 employees lump sum 100, - EUR per month, with companies more than 200 employees inclusive 200, - EUR per month. As a membership fee I choose:

EUR per month.

The contribution is reviewed annually on 01 August debited in advance or from date of admission pro rata for the first year.

I agree to the publication of my name, my role and my e-mail address on the Internet and / or (tick desired) in paper form to:

Yes
No

Place, Date:

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Signature after printing the form

Debit authorization

I hereby authorize the "SuMa-eV - association for free access to knowledge" to withdraw the membership fee debited from my account.

My bank, Bank Name:

IBAN:

BIC/Swift:

Place, Date:

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Signature after printing the form