Aktief Slip Member Sign Up Form 2

Sign up form
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
WUR Username*
WUR Registration Number*
WUR Email*
Study*

BESMCLMUEMES
Study Starting Date*

DayMonthYear
Date
Study Starting Date*
Phone Number*

Country CodePhone Number
Contribution (to be remitted around February)*

Automatic withdrawalIn cash (+1 Euro)Manual 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

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

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