Membership Application
Please print (ctrl P) and send to the following address by regular mail or fax:
Contact
GERMAN ORIENTAL SOCIETY FOR HIGHER EDUCATION
DEUTSCH-ORIENTALISCHE GESELLSCHAFT FÜR BILDUNG e. V.
Dr. Frank Höselbarth
Kapellenweg 73
65193 Wiesbaden
Tel.: (069) 2400 5655; Fax.: (069) 2400 5861
E-Mail: peoplebrand@aol.com
Membership Application
I hereby request membership
A. for myself only
B. for myself and my husband/wife/partner
C. for the company/association
(please cross through where inapplicable)
in the
GERMAN ORIENTAL SOCIETY FOR HIGHER EDUCATION
DEUTSCH-ORIENTALISCHEN GESELLSCHAFT FÜR BILDUNG e.V.
Surname……………………………………………
First name……………………………………………………
* For membership including partner
Surname of the husband/wife/partner ………………………………..
First name of the husband/wife/partner………………………………………….
* Company/organisation/association…………………………………………………..
Street………………………………………………………………………….
Postal code and town……………………………………………………………
Telephone…………………………………….; Fax:……………………………………
Mobile telephone…………………………………….
eMail…………………………………………………..
I hereby commit to payment of the annual membership contribution, currently:
Single Member: Minimum amount: € 60 ( ) or……………………………….
together with partner/family pass € 90 ( ) or………………………….
Student: € 25 € ( )
Firmenbeiträge/juristische Personen 450,00 €
and grant the society the right to withdraw the annual contribution from my account
Account number:………………………………………..
Bank………………………………
Bank Code……………..........................................
You will automatically receive a donation receipt from us for the annual contribution, which will allow you to claim the full amount as tax deductible on your tax return.
Date: ……………………………
……………………………………………………………
(Signature)