REQUEST FOR MEMBERSHIP
I would like to join the Ernst-Reuter-Gesellschaft der Freunde, Förderer und Ehemaligen der Freien Universität Berlin e.V.
(ERG) as follows and request hereby the membership (www.fu-berlin.de/erg):
Membership/ normal
Membership/ reduced
Institution / Company
Promotion membership
(minimum contribution: 50,00 €/year)
(minimum contribution: 10,00 €/year), students and alumni incl. the first three
years after de-registration (Exmatrikulation), please settle proof)
(minimum contribution: 150,00 €/year)
I am ready, instead of paying the minimum contribution of 50,00 €, to pay an
annual donation of altogether _____________(membership dues + donation).
I would like to join the Chapter ________________________________________(optional).
(see the chapter overview under the following link: http://www.fu-berlin.de/en/sites/alumni/erg/kapitel/index.html )
 Ms
family name
first name
 Mr
date of birth
@zedat.fu-berlin.de
Email
ZEDAT-Email
street (private address)
postal zip code
city/residence
academic degree
function / institution
telephone number
I studied at the FU from WS/SS_______ to WS/SS________
I was active at the FU from _________ to _________
I studied at the FU
worked
attained a doctorate
taught
completed
without degree
subject__________________________institute ______________________________degree ___________________________
I agree that my personal data provided in this request form will be stored for the following:
1. Processing of the data in the alumni database for internal use, especially to inform about ERG activities and FU
events.
2. Data transfer to the FU Berlin in the course of the FU Directory and Identity Service (FUDIS).
ZEDAT account: I agree that I will comply with the ZEDAT user regulations; I will not use the account for business or
commercial purposes, and I will not share my login information allowing third parties to use the account or other ZEDAT
institutions.
date
signature
SEPA DIRECT DEBIT AUTHORIZATION (FOR EUROPEAN BANK ACCOUNTS)*
Hereby I authorize the ERG revocably to draw in the payment of my contribution to the following account by debit
owner of account (if not member name)
name of bank und city
bank code
date
signature owner of account
account number
IBAN
BIC
Unterschrift des Kontoinhabers
______________________________________________________________________________________________________
ERNST-REUTER-GESELLSCHAFT der Freunde, Förderer und Ehemaligen der Freien Universität Berlin e.V.
Kaiserswerther Straße 16-18
Tel. 030 838 53077
Fax 030 838 453077
14195 Berlin
[email protected]
PLEASE KEEP THIS PAGE FOR YOUR DOCUMENTS
Information to the direct debit authorization
* If the indicated account does not exhibit necessary covering, no obligation exists for redemption on the
part of the account-prominent institute (see above). Partial redemptions are not made in the debit
procedure. The owner of an account takes over the back debit fee, if the direct debit could not be
accomplished by its being to blame for. Membership dues are drawn in to the indicated account by debit.
If you left an E-Mail address, you are informed approximately two weeks before debit. All membership
dues are charged by calendar year. Information about a new address or a change of account is requested.
Information for payment by transfer
In case you do not consent to the direct debit authorization procedure, we ask you to transfer the
membership dues for the current calendar year until June 30th to the following bank account:
Account Holder: Ernst-Reuter-Gesellschaft e. V.
Berliner Sparkasse, BLZ 100 500 00
Account number: 101 00 101 11,
IBAN: DE98 1005 0000 1010 0101 11
BIC: BELADEBEXXX
All membership dues are charged by calendar year. When joining the ERG after June 30th we ask you to
immediately transfer the membership due, which is valid until December 31st of the current year.
General Information
To Zedat account owners applies: if until October 31st no receipt is registered, the Zedat account can
temporarily be closed.
After receipt of membership dues on the ERG account, a donation confirmation for the tax office is issued
if desired. Donations up to EUR 200.00 can be proven also on the basis of the account statement (§ 50
Abs. 2 Nr. 2 Buchst. b EStDV). The ERG is recognized as non-profit association.
Membership dues of chapter members are credited to 60% to the selected chapter in accordance with § 8
of the ERG statute.
Please understand that the free distribution of publications is only possible for members who pay the full
membership dues. An online version will be available at: www.fu-berlin.de/presse/publikationen.
Our visitor address is: Malteserstraße 74-100, Haus S, 12249 Berlin (advance notification, Phone: 83853077).
Status: February 20th, 2015