membership 

and authorization form for monthly standing orders  

   Hereby I would like to apply for the membership of the International Free Women’s Foundation (IFWF). I would like to grant authorization to the IFWF to carry out standing orders, concerning  my contribution of €  monthly, from my bank account.

   Hereby I would like to become a benefactor of the IFWF. I will transfer an amount of  € a year to the bank account of the IFWF. (minimum amount of € 5)

Surname and initials                   male female

Date of birth                                                Profession  

Address                            

Postal code and town           

Country                               

Phone number                      

Bank                                    

Bank account                            Giro account

Date of entry of the membership             

Undersigned is familiar with the fact that she/he can, whenever she/he doesn’t agree with the standing orders, give her/his bank or giro office an order to book the money back on his/her bank or giro account within 30 days. 

Undersigned declares to accept the settlement as described above.

Date.......................              Signature:…………………………………………

  ________________________________________________________________________  

Please, print and send a signed confirmation by mail or fax to:

International Free Women´s Foundation • Willebrordusplein 10a • NL- 3037 TC Rotterdam

Fax: 0031 (0) 10 265 14 60  •  Tel.: 0031 (0) 10 465 1800  •  Postbank 6218545 (Netherlands)

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