Membership Application

Verein der Freunde und Ehemaligen des Max-Planck-Instituts für die Physik des Lichts e.V.

Position *

Please select Private individual (€50) Student (€15) Company / Organization (€1,000)

(Annual membership fee varies depending on selection)

Contact Details

Prefix *

Please select Mr Mrs Mx

Title

Last name, First name / Name of Company *

E-Mail *

Street and number *

Town/City *

Postal code *

Country *

Membership Fee

If applicable individual higher annual fee

€

Payment method *

Please select SEPA direct debit mandate Invoice

I authorize the Verein der Freunde und Ehemaligen des Max-Planck-Instituts für die Physik des Lichts e.V. (creditor ID: DE66ZZZ00002823227) to recurringly collect payments from my account by direct debit. At the same time, I instruct my bank to honor direct debits drawn on my account by the Verein der Freunde und Ehemaligen des Max-Planck-Instituts für die Physik des Lichts e.V.. Note: I can request a refund of the debited amount within 8 weeks of the debit date. The terms and conditions agreed with my bank apply. The mandate reference will be assigned at a later date.

If SEPA direct debit mandate

Account holder

IBAN

BIC

I am an MPL alumni and would like to receive information.

Please select: *

I hereby confirm that I am at least 18 years old.

I hereby confirm that I have read and accept the association’s statutes.

I hereby confirm that I have read and accept the association’s privacy policy.