Subscription form MSTV Ferro Mosae 2017-2018

Personal Information

Name                        :.........................................................................................                                                                    

Address                 :.........................................................................................

Postal code + city        :.........................................................................................

Telephone number        :.........................................................................................                                                                                                                                                                                                              

Email address         :.........................................................................................

Sex                        :  MALE / FEMALE
Date of birth+place :......................................................................................

Nationality                :.........................................................................................

Study/job                 :.........................................................................................

UM studentnumber         :.........................................................................................


Membership

The annual contribution fee for MSTV Ferro Mosae is €74,-. For spring members (after 1 March), the fee is €54,-. This includes a basic membership of The Dutch Triathlon Federation (NTB) of €34,- annually with 12x the NTB triathlon magazine.

Competition license

To participate in triathlon races you are required to have a race license. One can choose between a one-day license (to be obtained at the race organization) or an annual competition license. The costs of a one-day license range between €3,- and €40,- per race (depending on the distance of the race). An annual competition license of the NTB costs €25,-. The license will be automatically renewed until cancellation. Deadline for cancellation is 1 December.

The undersigned subscribes for the following MSTV FM membership*:

* Please tick the appropriate box for membership choice

Geusseltbad card

You will receive a Geusseltbad card, which provides access to the swimming pool during training hours. A one-time deposit of 5 euro will be charged. The deposit will be returned when you return the card to the secretary when ending the membership. In case of loss, a new card can be provided at the cost of 5 euro.

Membership cancellation

The membership runs from 1 October till 30 September. The membership can be cancelled with 4 weeks of notice. Cancellation needs to proceed by written notification (letter or email). Without timely cancelation, the membership will be automatically renewed for an extra year.

Authorization

I hereby declare to enter a membership at MSTV Ferro Mosae, until cancellation. I allow MSTV Ferro Mosae to debit the annual contribution fee from my account to the bank account of MSTV Ferro Mosae NL21 RABO 0151 5834 20 EUR until I end my membership.
IBAN no:........................................................................................................

BIC no:..........................................................................................................

Name :...........................................................................................................

City:.............................................................................................................                                                

Date :................................  Signature:............................................................

Total amount (excl. one-time deposit of 5 Euro for Geusseltbad card)

*Please tick the appropriate  box

Other questions

Would you be interested in joining one of our division teams? ................................................................................................................

Are you member of another triathlon club? If yes, what club? .....................................

Do you already have a NTB competition license at this club? If yes, what is your NTB license number? ...................................................................................................

Are you member of another sports club? If yes, what club? ........................................

If yes, do you have a competition license at this club? ...............................................

Can you think of someone who might be interested in sponsoring Ferro Mosae? ...........................................................................................................................

Contact in case of emergency

Home address (parents):.................................................................................

Postal code + city (parents):............................................................................

Telephone number (parents):...........................................................................


Submission of this form 

Please give the subscription form with a copy of your UM Sports card to one of the board members of MSTV Ferro Mosae, to the secretary (Jasper Stevens), or send it to ferromosae@gmail.com 


www.ferromosae.nl  -  ferromosae@gmail.com

KvK 14112874