Sergiu Celibidache Stiftung
HBäckerstr. 46
D - 81241 München
Yes, I would like to become a
friend
of the Sergiu Celibidache Stiftung with an annual contribution of Euro 100,-.
Yes, I would like to become a
supporter
of the Sergiu Celibidache Stiftung with an annual contribution of Euro 250,-.
Yes, I would like to become a
donor
of the Sergiu Celibidache Stiftung with an annual contribution of Euro 750,-.
Yes, I would like to become a
patron
of the Sergiu Celibidache Stiftung with an annual contribution of
Euro.
Yes, I would like to give a single donation of
Euro. (Please enclose a crossed cheque)
Authorization for direct debit
I hereby authorize the Sergiu Celibidache Stiftung München to withdraw the sum indicated above from my account via direct debit on January 1st of each year.
Financial institution
Bank Sort Code / SWIFT Number
Account number
Date
Signature
....................................................................
The payment will be renewed automatically for the following year, if not cancelled in writing by November 30th of the previous year.
Sender
Surname:
Christian Name
Street
Postcode / Town
Country
E-mail