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Sign-up form for Membership of the Association Wild Roots (Verein Wilde Wurzeln)
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Email *
family name *
first name *
title *
birth date *
MM
/
DD
/
YYYY
profession
street *
postal code, city of residence *
country of residence *
phone *
I heard of association wild roots through: *
I want to join as *
I thereby ensure to pay the membership fee to the following bank or paypal account *
Accounts
Bank:

account holder: Verein Wilde Wurzeln
IBAN: AT79 1420 0200 1097 3970
BIC: BAWAATWW

Paypal:
office@wildewurzeln.at
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The membership can be cancelled semi-annually.
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