Museum
FM - Murals
Pina Bausch Gallery
Quarters
Team
Contact
DE
EN
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
scanned
by e-mail: wupperone929.urbanart@gmx.net
Membership data
Company / Institution
First name
Surname
Street and
house
number*
Postcode*
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 Euro (twelve Euro)
I have enclosed proof of the reduction 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. I have completed the
SEPA direct debit mandate
has been completed.
SEPA
Direct
Debit Mandate*
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