Join BouT - Academic staff
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(Ing. Ir. Drs.)
Initials *
First name *
Family name *
Address *
Zip code *
City *
Phone number *
Email *
Date of birth *
Chair *
Department *
Automatic payment (automatische incasso) *
Academic staff: € 30/year
Bank account *
Please fill in IBAN format (example: NL99 INGB 0123 456 789)
Data Usage *
Praktijkvereniging BouT stores the information given in this form to keep record of its members. We may contact you by phone or email only if necessary. We do not share this information with third parties without your permission. If you would like to end your membership and remove your data, contact
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