Name |
....................................................................... |
Vorname |
....................................................................... |
Geburtsdatum |
....................................................................... |
Anschrift |
....................................................................... |
Telefon |
....................................................................... |
...................................... | ...................................... | ...................................... |
Datum | Vorsitzender/Vorsitzende | Mitglied |
Konto-Nr. |
....................................... | BLZ |
....................................... |
Geldinstitut |
....................................... |
...................................... | ...................................... |
Datum | Unterschrift |