I would like to become a member / a donor of the Juergen Wahn Stiftung e.V.

Please accept my annual membership contribution of (min. 15,- $) $ (US-Dollar)
Please accept my donor contribution in the amount of: $ (US-Dollar)
Choose your type and methode of payment, please:

Payment
Method of payment
Single donation (only transfer)    
Monthly Direct debit
Quartely Standing order
Semi-Annually Transfer
Annually Online bancing

If you choose "Direct debit" please provide the following:
Bank Name:
Bank Routing No.:
Account No.:

Address:
First Name / Last Name:  
Street:
City / Zip code / Country:
Phone / Fax:
e-Mail-Address:

OUR ACCOUNT
Juergen Wahn Stiftung e.V.
BANK NAME: Sparkasse Soest, Germany
SWIFT / BIC CODE: 41450075, ACCOUNT NO.: 22202 

resp.: IBAN ROUTING NO.: DE06 4145 0075 0000 0222 02
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