Individual affiliation appliance form

 

 
Please fill in ALL fields possible to avoid unnecessary requests - thank you! 

S'il vous plaît remplir tous les champs possibles pour éviter des demandes inutiles - je vous remercie!

Si prega di compilare tutti i campi possibili per evitare richieste inutili - grazie!

Bitte wenn möglich alle Felder ausfüllen, um unnötige Rückfragen zu vermeiden – danke!

 

Name
Name
Town / Street / ZIP-Code / Country
Legal Declaration *
I hereby declare to be fully insured against any possible accident that may arise during practice, and I wave out the responsability from the Association on this matter.

Bank Account Information

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