Application for APV-Membership

Please complete this application form. At the end of the form you have the option of sending it by e-mail or printing it out and sending it to the following address:

APV
Kurfürstenstr. 59
55118 Mainz, Germany
Fax: +49-6131-9769-69


I herewith apply for APV membership:

Personal data
Company address
Private address
Further details
Academic degree
Highest degree
Please indicate your main areas of interest
Field in which you are working presently
Payment information
In which membership category do you belong?
If payment by automatic debit transfer is chosen (only within Germany)
If payment by automatic debit transfer is chosen (from abroad)
I understand that should I be accepted as a member the above information will be stored in the APV's data base. The information will be protected in accordance with German Data Protection laws.*