Ärztenetz Billstedt-Horn

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Beitrittserklärung

Ich bitte um die Aufnahme in das Ärztenetz Billstedt Horn e.V.
Oskar-Schlemmer-Str. 15
22115 Hamburg

Name

Vorname

Nachname

Geburtsdatum

Fachgebiet / Zusatzbezeichnung

Praxis-Adresse

Privat-Adresse

Tel. Praxis

Kontoinhaber

IBAN

BIC

Name der Bank

Erklärungen

Die aktuell gültige Satzung habe ich zur Kenntnis genommen und erkläre mich sowohl inhaltlich als auch mit den Zielen des Netzes einverstanden und möchte dem Verein beitreten. Die Kündigungsfrist zum 30.06. und 31.12. eines Jahres habe ich zur Kenntnis genommen. Mit Unterzeichnung der Beitrittserklärung erteilen Sie die Einzugsermächtigung für den jährlichen Mitglieds-beitrag i. H. v. derzeit 100 Euro, der i. d. R. in der ersten Kalenderwoche des Jahres von dem o. g. Konto eingezogen wird.
Mit Unterzeichnung der Beitrittserklärung erteilen Sie die Einzugsermächtigung für den jährlichen Mitglieds-beitrag i. H. v. derzeit 100 Euro, der i. d. R. in der ersten Kalenderwoche des Jahres von dem o. g. Konto eingezogen wird.
Beitragsfreiheit im ersten Jahr. Ich habe zur Kenntniss genommen, dass das erste Jahr beitragsfrei ist.

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