Registration

Please provide your complete personal data in clear detail as this data will be used at a later date for the production of printed materials such as business cards. The annual fee for the AMGI membership will cost 72€ (incl. VAT*). Upon registration please decide if you would want an additional mini-homepage. The one-time total fee for the construction of the mini homepage is Euro 72.00 VAT included. If you have any questions, please contact us at schwemmlein@remove-this.aloe-medical-group.com

Please fill in all the fields, which are marked with a star (*). The data is confidentially sent via SSL to the web server.

!!! Plaese start your registration only if you have been invited by Dr. Schwemmlein or any other AMGI member.

Title

Profession*

User name*

First name*

Last name*

Street*

No.*

Zip code*

Town*

Country*

Cell phone*

Fax

E-mail*

alternative E-mail

Company

VAT Id. No.

Short information on you

Internet (URL)

Invoicing address (if different)

Street

No.

Zip code

Town

Country

Delivery Address (in different)

Street

No.

Zip code

Town

Country

Bank details

Name of the bank

Account number

Account owner

IBAN

SWIFT (BIC)

I agree that the membership fee and invoice amounts for order are deducted from my account.

Additional information

Your FLP IDNr

Recommended from

I want to appear on the public AMGI member list.

Costs/Booking

The annual fee for the AMGI membership will cost 72€ (incl. statutory VAT).

Set up a mini-website (with cost) for me (please click, if desired):

EUR 72.00 (incl. statutory VAT) ¹ mini-website

¹ Costs for mini-website are non-recurring

Comment

I agree with the general terms and conditions.*

Yes, I agree that my personal data will be used for the purpose of membership as described in the privacy policy.*

Note: by registering, I agree to receive the free AMGI newsletter. I know that I can unsubscribe from the newsletter at any time.

Captcha*

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