Aktief Slip Member Sign Up Form 2

Name*

First NameLast Name

WUR Username*

WUR Registration Number*

WUR Email*

Study*

BSc Environmental SciencesMSc Climate StudiesMSc Urban EnvironmentMSc Environmental Sciences

Starting Year*

Date of Birth*

Date

Phone Number*

Country CodePhone Number

Contribution*

Automatic withdrawalIn cashManual SEPA Transfer

I confirm that I will transfer the €10,00 payment 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 €10,00 from my transfer/bank account as payment of my membership. Payment will take place once every academic year. If I want to withdraw from my membership, 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 membership for the next academic year and I am obliged to pay €10,00 for that year of membership.

Signature for automatic withdrawal

I pay cash for a one-year membership (€10,00) for this academic year at the Aktief Slip Office: Forum room 112

Bank IBAN*

Signature*

By signing you agree to the regulations of Aktief Slip.

Please verify that you are human*

Sign up form