BECOME A

BVB MEMBER!

Yes, I want to becom

e a mem

ber of BVB

!

BV. B

orussia 09 e.V. Dortm

undStrobelallee 50D

-44139 Dortm

und G

ermany

Postage paid byFirst nam

e

I I I I I I I I I I I I I I I ISurnam

e

I I I I I I I I I I I I I I I I I I I

Mobile/Telephone num

ber

I I I I I I I I I I I I I I I I I I I E-M

ail

I I I I I I I I I I I I I I I I I I I

Street, house number

I I I I I I I I I I I I I I I I I I I P

ostcode, City/R

egion

I I I I I I I I I I I I I I I I I I I D

ate of birth D

ate of entry

I I I I I I I I I I I I I I I

Please complete with block letters Alternatively, the application can be completed online at www.bvb.de/mitglieder

Date, signature of m

ember. For persons under the age of 18, the signature of a legal guardian is

required. Applications on others’ behalf are not permitted.

I wish to becom

e a mem

ber of BV. B

orussia 09 e.V.

Ms./M

rs.

Mr.

Does your passion for BVB not know any country borders? Would you like to join other BVB fans abroad and become part of our worldwide black and yellow family? There are several benefits waiting for you! Become a BVB member!

Advantages of BVB membership:• Complimentary members’ magazine “Borussia”• Participation in the general assembly (from the age of 16 onwards).• Right to vote and speech (from the age of 18 onwards• Preferred treatment during ticket allocation via a special contingent of tickets designated for members for all home and away • Personal membership identity card• Welcome present incl. personalised certificate Alternatively, you can forgo your welcome gift* and do good. If you do so, BV. Borussia 09 e.V. Dortmund will make a donation of €10 to „leuchte auf“ – the BVB Foundation. * I am aware that for administrative and legal reasons, neither BV. Borussia 09 e.V. Dortmund nor „leuchte auf“ – the BVB Foundation can issue a donation certificate for the donation.

APPLICATION FOR ADMISSION as passive member to BV. Borussia 09 e.V. Dortmund.

Welcome present BVB Ballpoint BVB fan scarf Donation

Division General membership Football Table Tennis Handball Fan and funding department

Annual membership fee (admission fee not applicable)

62 EUR adults 30 EUR for adults with concessions* *Adults with a severe disability (50% or over). When claiming a concession, corresponding evidence must be provided.

30 EUR young persons (only up until their 18th birthday) For children up until their 14th birthday, please only complete the BVB KidsClub flyer!

1.909 EUR lifetime membership 120 EUR family membership Please only complete the application for admission entitled “Family Membership”, available to download from www.bvb.de/mitgliederIn the year of joining, the appropriate prorated membership fee will be debited.

Date and signature of account holder

Surname

I I I I I I I I I I I I I I I I I I I First name

I I I I I I I I I I I I I I I I I I I Street, house number

I I I I I I I I I I I I I I I I I I I

E-Mail

I I I I I I I I I I I I I I I I I I I

IBAN

I I I I I I I I I I I I I I I I I I I I IDE

BIC

I I I I I I I I I I I I I I I I I I I

Postcode, City/Region

I I I I I I I I I I I I I I I I I I I

SEPA Direct Debit Mandate, Creditor Identifier: DE29ZZZ00000088008I authorize BV. Borussia Dortmund (I authorise Borussia Dortmund football club) to debit my account the value of the annual membership fee (due 01 January each year) via direct debit. I simultaneously request my financial institution to honour direct debit requests from BV. Borussia 09 e.V. Dortmund. Please note: I can demand within 8 weeks from the initial date of liability the full reimbursement of the debited amount. The terms and conditions of my financial institution are applicable.

I agree that BVB (Borussia Dortmund GmbH & Co. KGaA, Ballspielverein Borussia 09 e.V. Dortmund; BVB Merchandising GmbH; BVB Event & Catering GmbH; besttravel Dortmund GmbH) will exchange my data between the listed organisations, who will process it jointly and use it for communication, analysis and email advertising purposes. Advertising includes, for example, ticket news, promotions and other products/services (such as fan merchandise, events) of BVB and its official partners.Further information on data protection can be found at https://www.bvb.de/eng/Data-Protection/Data- Protection-Provision or requested free of charge from Ballspielverein Borussia 09 e.V. Dortmund. Note: I can withdraw this consent in whole or in part at any time with effect for the future without giving reasons. An informal notification by post to Ballspielverein Borussia 09 e.V. Dortmund or to one or more of the above-mentioned BVB Group companies under the above-mentioned addresses, or an email to mitglieder@bvb.de or by telephone 0231 / 9020-0 is sufficient to withdraw consent. The withdrawal of consent does not affect the lawfulness of the processing carried out on the basis of the consent carried until the revocation.

Declaration of consent (please tick only if applicable)

Information on data protectionBallspielverein Borussia 09 e.V. Dortmund, Strobelallee 50, 44139 Dortmund, phone: +49231-4119, email: mitglieder@bvb.de, website: www.bvb.de/Der-Verein, collects, processes and uses your personal data for the proper execution of your active or passive membership in the club. Your personal data will only be passed on to third parties if this is necessary for collecting your contributions or for your participation in competitions. The provision and use of your personal data is necessary in order to manage your membership in Ballspielverein Borussia 09 e.V.. Without it, you will not be able to become a member. Further information on data protection can be found at https://www.bvb.de/eng/Data-Protection/Data-Protection-Provision or requested free of charge from Ballspielverein Borussia 09 e.V. Dortmund.

Become a BVB member now!