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Last Name

First Name

Gender

Birthdate

Street Name

House Number

Postal Code

City

Telefone

E-Mail

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Payment Options I will pay the minimum annual contribution of €50.00 I will pay an annual contribution of €100.00 I will pay a one-time contribution of €: I will pay an annual contribution of €:

One-time contribution in €

Individuals up to age 30 are exempt from the annual membership fee. In accordance with the bylaws of the James Loeb Society e. V., the annual membership fee is due on August 6 (James Loeb’s birthday). Please transfer the amount to the account listed below. We recommend setting up a standing order. Donation Receipt Donations are tax-deductible. You will automatically receive a receipt for your donation from us if the amount exceeds €300.00.

Question

• The personal data you provided in your membership application will be stored in JL Gesellschaft e. V.’s data processing systems and processed and used for the purpose of membership administration. JL Gesellschaft e. V. undertakes to treat your personal data confidentially and not to disclose it to third parties. You may at any time request, in writing, information about the data stored regarding you and, if necessary, request a correction. I consent to the storage, processing, and use of my personal data.

Place of Birth

Age

Permanent Address

City

State

ZIP code

E-mail

Phone number

Secondary phone number (if applicable)

College / University

Degree type and major

Other degrees (if applicable)

Country of passport