IRM - INSTITUT FÜR REGIONAL- UND MIGRATIONSFORSCHUNG		IRM - INSTITUTE FOR REGIONAL AND MIGRATION RESEARCH

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IRM-Application Form

application form

Institute for Regional and Migration Research (IRM) e.V.

c/o Thomas Geisen
Wehntalerstrasse 259/04
CH - 8046 Zürich

Application Form.

Family Name:

First Name:

Signature:

Telefone:

E-Mail:

I herewith submit my application for membership in the organization “Institute for Regional and Migration Research (IRM) e.V.”. I have read and understand the rules associated with such membership. I am in accord with my personal information being added to the computerized records of the Institute. Such information shall not be given to third person parties without my express authorization.

As a membership fee I will pay ...................... €/ year (minimum 30 € for single persons/60 € for institutions)

In addition I will donate ...................... €/ year

...................................... ..................................................

Place/ Date Signature

Authorization for the Transfer of Funds

I herewith authorize the “Institute for Regional and Migration Research (IRM) e.V.”
to transfer the indicated payments:

my yearly membership of ...................... €/ year

my yearly donation of ...................... €/ year

by the settlement date charge my account Nr. ............................................... with

Banking Institution: ................................ Bank Routing Number ................................

authorized through my signature as given above.

There is no obligation for payment on the part of the credit institution if my account doesn't contain the required amount. Partial payments are not to be undertaken using the debit note method

.......................................... ................................................................

Place/ Date Signature

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