Membership application natural person | MDKU e.V.

Membership Application

for a natural person

I hereby apply for membership of the Medical Device Knowledge Units MDKU e.V. association.

Title

First name^*

Family name^*

Street^*

Zip code^*

City^*

Birthday^*

E-Mail^*

Phone

Preferred communication^*

Recognition of the Articles of Association

By sending this application for membership, I accept the current version of the articles of association dated 19 May 2023 and the regulations of the association.

Date of application^*

Membership Fee

The annual membership fee is set out in the current membership fee regulations dated 28 December 2022. The following fees are currently charged:

Contribution group 1 - natural persons: € 60

The membership fee is due annually at the end of each year for the following year in accordance with (4)1 of the membership fee regulations and will be collected by direct debit from the account specified below. (The first contribution for the year of admission will be debited at the earliest 14 days after receipt of the application).

Alternative account holder

IBAN ^*

BIC^*

Consent to the collection of the membership fee by direct debit ^*

I authorise Medical Device Knowledge Units MDKU e.V. to collect payments from my account by direct debit. At the same time, I instruct my bank to honour the direct debits from MDKU e.V. to my account.

Note: I can demand reimbursement of the debited amount within eight weeks of the debit date. The conditions agreed with my bank apply.

Consent to data processing ^*

I have read and understood the data protection information (link to be provided). I consent to my data being stored, processed and used by MDKU e.V. for the purpose of contract fulfillment within the scope of membership.

The personal data collected for the above-mentioned purposes will be collected, processed, used and transmitted in compliance with the EU General Data Protection Regulation.

The declaration of consent is given on a voluntary basis. I have been informed that I can revoke my declaration of consent for the future at any time by written notification.

Before you can submit the form, you must confirm your email address :

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Membership Application

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