Application for APV-Membership

Please complete this application form. At the end of the form you have the option of sending it by e-mail or printing it out and sending it to the following address:

APV
Kurfürstenstr. 59
D-55118 Mainz, Germany

I herewith apply for APV membership.

Statutes of the APV

Election regulations of APV

Application for APV-Membership

Personal data

Form of address

Title

Surname*

First name*

Day of birth

Private address

Street*

Postal code / city*

Country*

E-mail*

Repeat E-mail*

Phone

Mobil

Company address

Company name*

Department*

Street*

Postal code / city*

Country*

E-mail*

Repeat E-mail*

Phone

Mobil

Further details

Please indicate your main areas of interest

1.*

2.*

3.*

Highest degree

Your current position

How did you learn about the APV?

Correspondence to*

Contribution invoice to*

Payment information

In which membership category do you belong?*

Category I: 130 €

Category II: 25 € student/ doctoral student (only upon application)

Category III: 40 € retiree (only upon application)

Upload salary certificate or pension certificate

Payment method

If payment by automatic debit transfer is chosen (only within Germany)

Name of bank

Account holder

IBAN

BIC

I understand that should I be accepted as a member the above information will be stored in the APV's data base. The information will be protected in accordance with German Data Protection laws.

Consent to data protection
Detailed information on handling user data can be found in our privacy policy

I confirm that I have read and understood the statutes. By submitting my application for membership, I declare my acceptance of the statutes.

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