Declaration of membership Wilson's Disease Organisation Germany (Morbus Wilson e.V.)

I hereby declare my joining as a member of the Wilson's Disease Organisation Germany (Morbus Wilson e.V.).

The annual membership fee is currently EUR 40 for individual members and EUR 70 for family memberships, payable by February 1 of the respective year.

Date of birth:*

Why do I want to join the Wilson's Disease Organisation Germany (Morbus Wilson e. V.)?

Family members (first name, surname, date of birth) *for family membership:
We strive to provide services tailored specifically to children and young people. To do this, we need you to provide the date of birth.

How did you hear about Wilson's Disease Organisation Germany (Morbus Wilson e. V.)?

Morbus Wilson e.V. stores my personal data exclusively for statutory purposes, in particular to facilitate membership administration. The collection, processing and use of the data is carried out in compliance with the GDPR and the current version of the Federal Data Protection Act. The data will not be passed on to third parties outside Morbus Wilson e.V.

I agree that this information may be stored for the duration of my membership in order to pursue the statutory purposes of the organisation's self-help activities. I can revoke this consent to the organisation at any time.

I agree to the disclosure of my name and address to other members of the Morbus Wilson e.V. organisation solely for the fulfilment of statutory purposes:

SEPA Direct Debit Mandate for SEPA Core Direct Debit Scheme

Name and address of the payee (creditor)

Morbus Wilson e. V.
Seefeldstraße 28a
97273 Kürnach

Recurrent Payments

Creditor identification number (CI/Creditor Identifier)
DE20ZZZ00000452696

Note: In the year of joining, the contribution due will be collected on the 1st business day of the month following the month after joining and in future on the 1st business day of the due month determined by the General Meeting.

Note: I/we can request a refund of the amount debited within eight weeks of the date on which the amount was debited. The conditions agreed with my/our bank shall apply.

The application was made for*

Note

If you are unable to provide a SEPA Direct Debit mandate, please send us the completed PDF registration form, omitting the page relating to the SEPA Direct Debit mandate.