Alborz Association Membership

Alborz Association Membership Form

Please fill out the form to become a member of the Alborz Association
Using this form you can register for D.I.S.A. Alborz membership on the condition that you are affiliated with a university in the Netherlands.

Becoming a member gives you perks, such as discount on paid activities, access to certain activities and the chat group of members.

Non-members are welcome to participate in activities open to all, but not those exclusive to members.
Name*

First NameLast Name
Birth Date*

MonthDayYear
Sex
Personal E-mail*
Phone Number*
Nationality*
What is your position in the academic field?*
Which university are you or your partner affiliated with? *
Provide at least one:

verify your email or upload a document
University Email Validator*
Please provide a valid document supporting your affiliation with your university (your diploma, admission letter, student card, etc)*

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Any other remarks and/or questions that you would like to share with us?
Would you like to be added to the Telegram group of Alborz?
Telegram Phone Number

Country CodePhone Number
Should be Empty:

Alborz Association Membership Form