LAX-500 Membership Form
LAX-500 consists of lacrosse enthusiasts that donate € 100 a year to support The Dutch Lacrosse Program. Being a LAX-500 member is a five year commitment that provides much needed stability for our growing program. Your donation will directly contribute to our national teams and the overall growth of the sport in The Netherlands.

Becoming a LAX-500 member means a lot to us and we’re extremely grateful for your contribution and support. Thank you for filling out the form below.

If you have any questions, comments or concerns, please contact us at:
Sign in to Google to save your progress. Learn more
Title *
Last Name *
First Name *
(or initials)
Your e-mail address *
This e-mail address may be added to the mailing-list *
Rest assured, you will not be flooded with messages
My donation goes to: *
LAX-500 members are listed on our website. Please specify how you’d like your name to appear. If you’d prefer to remain anonymous, write “no mention” in the space below. For other promotional requests please email
My name will appear on the website as follows: *
(maximum 30 characters including spaces)
By completing and sending this form, you become a LAX-500 member for five years. It’s critical for our planning that we can rely on your contribution for the entire five year period. Once again, thank you for your support.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy