Mandate for recurrent collections on behalf of Friends of the MSS Research Foundation I am a friend of the MSS Research Foundation. I authorise the MSS Research Foundation to send recurrent collection instructions to my bank to debit my account and my bank to debit my account on a recurrent basis. The amount is:Euro This amount is: Yearly Every six months Quarterly MonthlyName Street and number Postal code City Email Bank account number Yes, I would like to recieve the MSS newsletter (max. 3 times per year) You will receive a confirmation mail.As parts of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Ask your bank for the conditions.Thank you for your support!MSS (Marshall-Smith Syndrome) Research Foundation | Oeverbiesstraat 20 | 2548 WP The Hague | The Netherlands | www.marshallsmith.org | info@marshallsmith.org | Registered KvK 27309021 | RABOBANK NL83 RABO 0140 3511 59 Enter verification code Powered by ChronoForms - ChronoEngine.com
