Membership - Healer Network
Enter your personal data:
First name *
or spiritual name
Your answer
First name *
Your answer
Last name *
Your answer
Name of corporate entity
Only fill in if corporate entity applies for membership
Your answer
Street 1 *
Your answer
Street 2
Your answer
Post code/zip code *
Your answer
City *
Your answer
Country *
Your answer
Email
Your answer
Phone
Your answer
Place of birth *
Your answer
Date of birth *
Your answer
Type of membership *
Please chose between an active or supporting membership
Healing method
Only for healers: Which healing method do you practice? (multiple methods can be listed!)
Your answer
Membership fee *
You can pay the membership fee of 120€ at once or in two rates of 60€.
Payment method of membership fee *
Direct debit = deducted automatically, Bank transfer = you transfer the money yourself
**IBAN
Only indicate if paying by “direct debit”.
Your answer
**BIC
Only indicate if paying by “direct debit”.
Your answer
**Name of account holder
(Only necessary if account holder is different to name on application)
Your answer
INSHA e.V. Charter *
(See above for pdf document)
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