Application

Titel

First-, Lastname

Private address

Institut

Department

Work address

E-Mail

Phone

Fax

Employed as?

Expertise

Ich gebe mich damit einverstanden, das meine persönlichen Daten für kommunikations Zwecke, die den Vereinbetreffen, verwendet werden

Contribution

€35 (standard membership fee)

€15 (reduced membership fee for Students, PhD Students, Postdocs)

€60 (membership fee for commercial organisations)

First & last name

Bank Name

BIC

IBAN

The information below will allow DGDR to withdraw annual membership fees, from your account.