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Membership Aplication

Given Name: Name:
Steet: Number:
Postcode: Country:
e-mail: Phone:
I agree
to pay the yearly membership fee of 20 Euro (60 Euro for Enterprises).
to make a donation of Euro per quater of a year, half yearly, yearly.
to make a single donation of Euro in addition to the yearly membership fee.

I will transfer the money to the account of Nepal Relief Association Aachen.
Account No 210 000 0019, Bank Code 390 601 80 (Aachener Bank)
I give a direct debit authorisation to Nepal Relief Associatio Aachen.(This will make our work much easier!)


Direct Debit Authorisation

Please debit the above stated amount from my acount:
I can cancel this agreement at any time. A simple protest at my bank will be sufficient.
Account Number Bank Code
For foreign accounts:
IBAN SWIFT-Code


Date, Signature ________________________________________________________


Please print this Form and send it to the following address:

Nepalhilfe Aachen e.V.
Matthiashofstr. 28-30
52064 Aachen
Bärbel Binding Zuletzt geändert: Sat Feb 10 23:19:41 2007