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Snellius membership form
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Email
*
Record my email address with my response
First Name
*
Your answer
Last Name
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
TUDelft email address
*
Which ends on @student.tudelft.nl in case you are a student
Your answer
Personal email address
*
We may want to contact you some time long after your tudelft email adress expires!
Your answer
Repeat personal email address
*
Your answer
Phone number
*
Mobile number you currently use
Your answer
Home address: Street and number
*
Your answer
Home address: Zip code
*
Your answer
Home address: City
*
Your answer
Nationality
*
Your answer
Are you a student or PHD?
*
Student
PHD
Background
*
What and where did you study? Study/University/Country
Your answer
In case of PhD: What is your PhD about?
Just out of interest!
Your answer
Send me a copy of my responses.
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