Declaration of accession

I will join the Association Friends of World Doctors Orchestra e.V.

Title, gender

First name *

Surname *

Date of birth *

Street *

ZIP code *

City/State *

Country *

Phone *

FAX

e-mail address *

Annual subscription to the amount of: *

I hereby declare to join the Association Friends of World Doctors Orchestra e.V. as a supporting member and dispose to pay an annual subscription to the above-mentioned amount (minimum membership fee for individuals 50 € per annum). I authorize the payment without further request to:

Friends of World Doctors Orchestra e.V.
Deutsche Apotheker- und Ärztebank
Bank code: 300 606 01
Account number: 000 306 2465

IBAN: DE26300606010003062465
BIC: DAAEDEDD