1

Mitgliedsdaten

2

Einzugsermächtigung

Mitgliedsdaten

* {{ validation.first_name[0] }}
* {{ validation.last_name[0] }}
* {{ validation.email[0] }}
* {{ validation.place_of_birth[0] }}
* {{ validation.date_of_birth[0] }}
{{ validation.marital_status[0] }}
* {{ validation.nationality[0] }}
* {{ validation.work_address[0] }}
* {{ validation.home_address[0] }}
* {{ validation.mobile_number[0] }}
{{ validation.personal_phone_number[0] }}
{{ validation.work_phone_number[0] }}
* {{ validation.job[0] }}
{{ validation.study_end_date[0] }}
* {{ validation.specialization[0] }}
{{ validation.medical_interests[0] }}
{{ validation.talent[0] }}
{{ validation.notes[0] }}
* {{ validation.date_and_place[0] }}
{{ alert_message_error }}

Einzugsermächtigung

Erteilt durch

* {{ validation.first_name_and_last_name[0] }}
* {{ validation.street_name_and_number[0] }}

Zum Zweck

Jahrlischer Mitgliedschaftbeitrag :180 Euro

Meine Kontoverbindung lautet

* {{ validation.bank_name[0] }}
* {{ validation.iban[0] }}
{{ validation.bic_or_swift_code[0] }}
* {{ validation.step2_date_and_place[0] }}

{{ validation.step2_igree[0] }}
{{ alert_message }}