Declaration of Accession Motorglider Association
 

Motorsegler-Interessengemeinschaft

Irmin Barnert   Lauenhägerstr.15   D-31655 Stadthagen
Tel.-Fax: 05721/5477   Mail:Vorsitzender@Motorsegler-ig.de   www.Motorsegler-IG.de

 
Declaration of Accession
 
I`d like to get a member of the Motorglider association.

 
Name: _____________________________________ Date of birth: ________________________________________
1st Name: _____________________________________ Tel No. ________________________________________
Street: _____________________________________ Fax: ________________________________________
Zip/City: _____________________________________ Mail: ________________________________________


 

I agree, that the annual premium of 18 Euro will be debited from my account. In case I forget to inform about a change of my account, I will cover the resulting charges. (For foreign country members: Those will initiate a bank transfer to the below mentioned International account number)  
   
Bank: _______________________________________________________________________________________________________
Bank_ID: __________________________________________ Account-Number: ________________________________________
Acc.-Owner: _______________________________________________________________________________________________________



I declare to have appropriate insurance coverage to operate a Modell Motorglider.
 
At: ____________________________________ Member-ID: ________________________________________


 

I agree, that my name, city and country is shown in the public Memberlist on our Website for all visitors. My complete address, with phone number and E-Mail address will be made available for the members in the password-secured part of our homepage.
Yes: ___ No: ___
 

The membership is for one year each and extends automatically, but can be cancelled any time without the need to declare the reason of cancellation.
 
Date: __________________________________________ Sign: ________________________________________
 
 

Bank account:                   Joachim Henke    Sparkasse Bad Kissingen, BLZ:79351010  Kto: 8286148
Reason for Payment:        MoSe-IG
 

International account( IBAN ): DE 52793510100008286148
Bankidentifikation  ( BIC ):  BYLADEM1KIS            Reason for Payment:        MoSe-IG

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