Membership Application

Membership

I wish to become a of the Society for Medicinal Plant and Natural Product Research (GA).

Please select membership *

Personal Data

Organisation

Salutation

Degree

Date of birth (dd.mm.yyyy)

First Name

Family Name

Business Address

Street Address

ZIP Code

City

Country

Phone

Fax

E-Mail

Home Address

Please enter your home address (optional)

Add

File upload (Student ID)

Student ID (Voluntary upload)

Please upload your student ID (PDF)

Allowed file formats: Everything except for .php, .sql, .bat

Payment

Please select payment *

SEPA Direct Debit

By signing this mandate form, you authorise (A) the Creditor to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from the Creditor.

As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can obtain from your bank.

Account owner

Account number (IBAN)

SWIFT/BIC

Bank Transfer: Please wait for our confirmation mail with your member number.

Paypal: Please wait for our confirmation mail with your member number.

If you want to use a different payment provider please enter the name:

Payment provider

Online subscription of Planta Medica

back to 1998 (60€)

back to 1953 (100€)

Privacy and declaration of consent

I have read and agree to the following Privacy Policy Statement:
I accept that my data will be used for GA internal purposes only.
By providing my email address, I agree to receive infrequent emails from GA.
This agreement can be revoked at any time with prospective effect.
www.ga-online.org/privacy-policy/

Bylaws:
I read the bylaws of the GA www.ga-online.org/about-ga/bylaws-of-the-ga/ and accept the processing and storage of my personal data for purposes regarding my membership in the GA.

I confirm that I have truthfully filled in all of the above information and I give permission to carry out the SEPA debit for the selected contribution.