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:

Application for APV-Membership

Personal data

Form of address

Title

Surname*

First name*

Day of birth

E-mail*

Company address

Company name

Department

Street

Country

Postal code / city

Telephone

Fax

E-mail

Private address

Street

Postal code / city

Country

Further details

Academic degree

Highest degree

Please indicate your main areas of interest

Field in which you are working presently

Your current position

How did you learn about the APV?

Payment information

Post

Attention: Seminar related documents are always sent to the company address.

In which membership category do you belong?

Category I: 130 €

Category II: 25 € student/ doctoral student

Payment method

If payment by automatic debit transfer is chosen (only within Germany)

Name of bank

IBAN

BIC

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.

Consent to data protection
Detailed information on handling user data can be found in our privacy policy

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