AG Interessengemeinschaft
Asclepiadaceen
(IG Ascleps)
Online Membership Application Form
Please fill out all
applicable fields as correctly and completely as
possible. Many items on this membership form will
be used for correspondence and mailing purposes.
Fields marked with an asterisk (*) are required.
Please print the IG
Ascleps membership form and post it to:
Please, do not forget
to sign the membership form.
Personal Information (First
resp. Full Membership) Note: The
subsription for a calendar year is EUR 12.00 and includes three
journals. The subscription is payable in advance.
Members joining during the year receive all issues of the journal published
during the year of joining.
Salutation/Greeting:
Family/Last
Name:*
First
Name:*
Middle Initial or Name:
Surtitle:
Date
of Birth:
.
.
(DD.MM.YYYY)
Personal Information(Second resp. Accociate Membership) Note: An accociate membership is open to the
full members' spouse or partner, the full member is living with (cohabitation). The
annual fee
for an accociate membership is EUR 6.00. Accociate membership dues
does
not include the receiption of journals.
Salutation/Greeting:
Family/Last
Name:*
First
Name:*
Middle Initial or Name:
Surtitle:
Date
of Birth:
.
.
(DD.MM.YYYY)
Mailing Address
Address Line
1:*
Address Line 2:
Address Line
3:
City:*
Zip/Post
Code:*
Country:*
Home Telephone:
Fax:
Email
Address:*
Confirm Email
Address:*
Homepage:
Method of Payment*
Bank Transfer
Payment must be made in Euro and drawn on Raiffeisenbank
Hersbruck, IBAN: DE 75 7606 1482 020 280 44
09, SWIFT/BIC: GENODEF1HSB.
Cash
Others
I
agree to have my name and address included in the membership rooster of
the IG Ascleps.*
How did you hear about
IG Ascleps?
I
am member of the "Fachgesellschaft andere Sukkulenten"
(FGaS).
