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    gender

    first name

    Surname

    Date of birth

    Street and house number

    address supplement

    Zip code

    Residence

    Country

    Phone

    Mobile

    Shipping method for magazine "Die Orchidee" (full members only)

    Preferred contact

    membership

    of full member:

    Please e-mail document to dog@orchidee.de

    Start of membership: 01.01.20

    Signature (with pointing device like mouse, pen or finger):

    SEPA direct debit mandate for the Deutsche Orchideen-Gesellschaft e.V. (D.O.G.)

    I hereby authorize the D.O.G. to collect the membership fee according to the SEPA basic procedure until revoked starting with the year:

    20

    Account owner:

    Bank:

    IBAN:

    BIC:

    Date:

    Signature (with pointing device like mouse, pen or finger):

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