Registration GEOS
By filling in this form you agree with the 'statuten' and rules and regulations of GEOS, the rules and regulations can be provided upon request, the 'statuten' can be viewed on request at the chairman of GEOS.
Surname *
Your answer
Initials/Initialen *
Your answer
Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Nationality
Your answer
Sex *
Address *
Your answer
Number *
Your answer
Postcode *
Your answer
City *
Your answer
Phone number *
For example/bijvoorbeeld +31612345678 / 0612345678
Your answer
Email *
Your answer
Bank Account/Bankrekening (IBAN) *
Your answer
Payment Authorization/Betaalmachtiging *
Occupation/Beroep *
If employed at a company provide company name in 'other'/indien werkzaam bij een bedrijf vul bedrijfsnaam in bij 'other'
Starting Year/Start Jaar
Your answer
Interest *
Multiple answers are allowed/meerdere antwoorden mogelijk
Required
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