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De Luxe Membership & Certification Packet Application: your own Dojo/Training Group/Association/Club Name:........
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Fullname:..........................................................................................................................................
Adress & Post Code:..........................................................................................................................
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Country:......................................................................................................D.o.B.:.............................
Phone:.......................................................................Fax:.................................................................
Email:...............................................................................................................................................
Highest Grade:......................... Style:................................................................................................ Other Grades & Styles:.
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Number of Clubs:................., Number of members ( approx ):......................... I enclose proof of my highest Rank Certificate and the Fee 60 Euro + 10 Euro for S &H
Payment Details: 
All admission fees must be paid before membership/ order is issued by either: O Western Union ( + 20 Euro Western Union Fee ) O Pay Pal (
+ 3,9% of Total = Pay Pal Fee ) O Creditcard via Pay Pal ( + 3,9% of Total = Pay Pal Fee ) O Cash (by insured or registred Mail )
O Cheque ( + 20 Euro more Cheque Fee ) O Bank Transfer ( + 15 Euro more Transpfer Fee ) Bank name: Volksbank Hameln-Stadthagen e.G.
BIC: GENODEF1HMP IBAN DE15 2546 2160 0023 8350 00 Holder: MAA .
With my signature I confirm the correctness of my data.
Date:............................. Signature:...............................................................................................
Send to: MAA-I., Fasanenweg 3a, D-31655 Stadthagen, Germany, Fax: 05721/ 72866, info@MAA-I.com |
