E-Registration Form

First Name*
Last Name*
Initials
Phone number

Country CodeArea CodePhone Number
Address
Zip code
City of Residence
Country of Residence
Nationality
personal non-student email*
example@example.com
Are you a student or a teacher?

Honours StudentHonours TeacherNot affiliated with Honours Programmes
- Study programme
- Are you a Bachelors or Masters student?
  
  BachelorsMasters
- Which Honours track are you following?
- DepartmentChair
- Employee number
- Privacy Statement*
  
  I allow processing of my personal data in correspondence with the privacy statement that can be found on https://hv-ockham.nl/s/HV-Ockham-Privacy-Statement-ENG.pdf
- Consent for Publishing Photos
  
  I also allow H.V. Ockham to take pictures during activities and publish these in promotional material.
- Place*
- Date*
  
  MonthDayYear
  Date
- Signature*
- Membership Contributions
  
  I authorize HONOURS VERENIGING OCKHAM to send recurrent collection instructions to my bank to debit my account and I authorize my bank to debit my account on a recurrent basis in accordance with the contribution collection instructions from HONOURS VERENIGING OCKHAM. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited.
- Other Contributions
  
  I also want to authorize HONOURS VERENIGING OCKHAM to send recurrent collection instructions to my bank concerning debt other than contribution.
- Debtor name
- IBAN
- BIC
  Not required if you have a Dutch bank account
- About the membership: Contribution for the first year is set at € 12,50 (subject to changes The member can accept the preauthorized debit of their debt by HONOURS VERENIGING OCKHAM by filling out the authorization on this form. The creditor information is as follows:
  
  Creditor name: HONOURS VERENIGING OCKHAM Address:PO Box 217 Zip code: City: Country: Creditor ID:
  
  If a member is unwilling to reconcile with the preauthorized debit system, payment may occur in a different way. A member stays a member until they, after written notice (or email), receives a confirmation of the board of the association. There is a notice period of four weeks. Cancellation is only possible if that member has no outstanding debt at the association. Membership fee is non-refundable. If the member accepts the preauthorized debit system, address changes should be communicated to the secretary within 14 days. This can be done in writing or by email.
- Should be Empty: