Personal data:

Last name:*

First name:*

Street:*

Postal code:*

City:*

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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.

Account owner:

Bank:

IBAN:

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