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First name
*
Last name
*
Phone number
*
Email
*
Company
*
Membership fee
Membership fee
A
I would like to pay the minimum amount of 100€ per year (regular)
*
B
I would like to pay the minimum amount of 300€ per year (club)
C
I would like to pay the minimum amount of 500€ per year (benefits)
D
I would like to become a patron of Pickle Bar
I would like to pay via:
*
Untitled checkboxes field
I herewith apply for a membership to Pickle Raum gUG (Pickle Bar)
*
Submit