By completing this registration form and remitting 250 Euro to the HWV trustee account you will become a participant in the Help for Wireless Victims program.
I am transferring the participant fee of 250 Euro into the following trustee account:
Kontoinhaber: Reiner Lang - Rechtsanwalt
Konto-Nr.: 1000101285 Stadtsparkasse
Bankleitzahl (BLZ): 701 500 00 München
Verwendungszweck: EMR-IP/H W V
IBAN: DE 82 70150000 1000101285
BIC: SSKMDEMM
This payment constitutes my enrollment in the Help for Wireless Victims Initiative program. With my signature,
I authorize that my personal and medical data may be used within the framework of HWV.
The enrollment fee is one-time and entitles me to all diagnoses, treatments and other information related to my health issues.
I may opt out of the HWV program at any time. Due to the inclusive nature of the HWV program.
I have read all the statements pertaining to the HWV program and agree with the terms and protocols.
