Personal data:

Last name:*

First name:*

Street:*

Postal code:*

City:*

Country:*

Direct Debit Mandate

I hereby authorize the International Association of Sound Massage Therapy, Ortheide 29, D-27305 Bruchhausen-Vilsen, for payments from my / our account by direct debit authorization. At the same time, I instruct my credit institution to encash the direct debits drawn by the payment recipient on my account. This mandate is valid until canceled.

Account owner:

Bank:

IBAN:

BIC/SWIFT:

Spamprotect:* Please enter the result of "10 + 20":