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FM - Murals
PINA - Murals
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Membership application
I hereby apply for membership of the association WupperOne929 UrbanArt e.V.
By post: WupperOne929 UrbanArt e.V. ● Hünefeldstraße 85 ● D-42285 Wuppertal ● or
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by mail: wupperone929.urbanart@gmx.net
Membership data
Company / Institution
First name
Surname
Street and house number
*
Zip code
*
Place of residence
*
Date of birth
Telephone landline
Mobile phone
e-mail
Annual contributions (please mark with a cross)
*
Individual or cultural association / annual contribution 24 euros (twenty-four euros)
Reduced contribution (pupils, students, trainees, pensioners) or family contribution (from 2nd person) / annual contribution 12 euros (twelve euros)
I have enclosed proof of discount with this form.
Proof of discount (if applicable)
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The membership fee is due annually on January 31 and is collected by direct debit. The
SEPA direct debit mandate
I have filled out.
SEPA direct debit mandate
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