Enrollment Declaration for the club United AI e.V.

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Hereby I am applying for a membership in the club United AI and accept the current

constitution from the 14th June of 2022.

I agree that pictures which are taken during club activities, can be published on the club sites (e.g.

websites, Instagram). I agree that I would like to be informed about club activities exclusively via
electronical ways (e-mail, Discord).
If I am not content with this, I will take action and write to the club board.

Email *

Surname

First Name *

Birthday *

YYYY

Street and House Number *

Postal Code and City *

Country *

Student Email *

Private Email

Mobile number
*

Moblie Number added to the Watsapp Group *

Yes

Discord Name

Matriculation Number *

Academic Course

Target Degree

Current Semester

Sepa Mandate

Bank datas:
United AI e.V.
IBAN: DE45741900000001530917
BIC: GENODEF1DGV

VR GenoBank DonauWald eG

Issuance of a direct debit authorization and a sepa direct debit mandate fort the in the constution
(see § 5) defined membership fee of 15€ per semester. The fee will be collected in the winter
semester on the 1st of December and in the summer semester on the 1st of Mai.

By completing and submitting this form, you authorise United AI e.V. to send instructions to your bank to debit your account and authorise your bank to debit your account in accordance with those instructions.
You are entitled to a refund from your bank under the terms and conditions of your agreement with the bank. A refund must be claimed within 8 weeks starting from the date your account was debited.

1. Direct debit mandate
I authorize United AI to collect the membership fee on schedule. I can withdraw from this
authorization any time.

2. SEPA direct debit mandate
I authorize United AI to collect payments from my bank account through debit. I instruct my
bank to encash debits of United AI of my bank account. I was informed, that I can revoke
debits 8 weeks after a collection without any reason from my bank. The with my bank agreed
conditions are applying.

Unique mandate reference number (the XXXXX stand fort he your individual club number,
which will be given to you by the club. Example: If your club number would be 00001, you
unique mandate reference number would be DE04UNITEDAI00001SEMESTERBEITRAG):
DE04UNITEDAIXXXXXSEMESTERBEITRAG

Name and address of the depositor (only needed if club member and depositor are not the
same person):

Surname_depositor

First Name_ depositor

Street and House Number_ depositor

Postal Code and City_ depositor

Country_ depositor

Account Data

IBAN *

BIC *

Digital Consent *

I confirm that I authorise United AI e.V. to debit my bank account in accordance with SEPA Direct Debit rules. I understand my rights regarding refunds and have provided accurate information.

Required

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