Sign-out form

Sign-out form

Fill in this form to be removed from the Aktief Slip administration and payment list, and to sign off from our email list.
Name*

First NameLast Name
WUR-Email*
example.example@wur.nl
WUR-ID*
Which year are you?*
Personal email (If you would like to stay connected!)
example@example.com
Why are you signing out?*

I have graduatedI do not get value for my moneyI am no longer interested in the associationOther
Signature*

Clear
By signing you indicate that you wish to remove yourself from the Aktief Slip administration, and wish to stop paying (if the payment time has already occured, filling this form will not reimburse the money).
Would you like to become a patron? The minimum patronage amount is €15 per year. As a patron, you will receive our GreenInk and Almanac publications, can be invited to activities by the board, participate in the General Members Meeting, and have voting rights in the General Members Meeting.*

YesNo
Patronage Amount (Minimum €15) *
Contribution*

Automatic withdrawalIn cashManual SEPA Transfer
I confirm that I will transfer a minimum of €15,00 when requested by Aktief Slip. I will receive an email from treasurer.aktiefslip@wur.nl with the payment details.
By signing for automatic withdrawal I authorize Aktief Slip for the automatic withdrawal of a minimum of €15,00 from my transfer/bank account as payment of my patronage. Payment will take place once every academic year. If I want to withdraw from my patronage, I will send a written notice (a letter or an email) to Aktief Slip before 1st September of the year. If I send the written notice later, I have automatically renewed my Aktief Slip patronage for the next academic year and I am obliged to pay a minimum of €15,00 for that year of membership.
Signature for automatic withdrawal

Clear
I pay cash for a one-year patronage (minimum €15,00) for this academic year at the Aktief Slip Office: Forum room 112
Bank IBAN*
Signature

Clear
By signing you agree to the regulations of Aktief Slip.
Please verify that you are human*
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