Personal data:

Last name:*

First name:*

Street:*

Postal code:*

City:*

Phone:*

Fax:

E-Mail:*

Homepage:

Date of birth:*

(dd.mm.yyyy)

Profession:*

Training

Please indicate the Peter Hess-sound massage seminars that you have taken so far:

Sound massage I

year:

in (location):

Instructor:

Sound massage II

year:

in (location):

Instructor:

Sound massage III+IV

year:

in (location):

Instructor:

Intensive training

year:

in (location):

Instructor:

Direct Debit Mandate

I hereby authorize the European Association of Sound Massage Therapy, Ortheide 29, D-27305 Bruchhausen-Vilsen, for payments from my / our account by direct debit authorization. At the same time, I instruct my credit institution to encash the direct debits drawn by the payment recipient on my account. This mandate is valid until canceled.

Accout owner:

Bank:

IBAN:

BIC/SWIFT:

Membership list, personal experience accounts, membership stamp

Please answer the following questions with yes or no:

I agree to the publication of my name as part of the membership list on the website of the Europäischer Fachverband Klang-Massage-Therapie e.V. (European association of sound massage therapy).

I agree to the publication of my personal experience accounts.

I would like to order the membership stamp at the one-off cost price of Euro 5,- (if you do, please transfer the additional Euro 5,- with your first membership fee payment).

 With this application form I hereby file for membership with the Europäischer Fachverband Klang-Massage-Therapie e.V. (European association of sound massage therapy) whose statutes I have read.

The membership fee of Euro 49,- at the moment is to be transferred at the beginning (January) of each year.
The checkboxes marked with * are compulsory and must be filled in.

Bank details:
Europäischer Fachverband Klang-Massage-Therapie e.V.
Kreissparkasse Syke, Deutschland
Account no.: 15 10 04 10 21, Bank code: 291 517 00
IBAN: DE43 2915 1700 1510 0410 21, BIC: BRLADE21SYK

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