ELSA Groningen Membership Form
We are glad you've decided to join ELSA Groningen! Please fill in the form below and in case you have any questions, please contact our Secretary General - secgen@elsagroningen.nl.
Naam / Name *
Your answer
Geboortedatum / Date of birth *
Your answer
E-mailadres / E-mail address (please don't use your student e-mail) *
Your answer
Nationaliteit / Nationality *
Your answer
Geslacht / Gender *
Studentennummer / Studentnumber *
Your answer
Studierichting / Study programme *
Your answer
Jaar start studie / Year of study (for example 2016) *
Your answer
Telefoonnummer / Phone number *
Your answer
Adres / Address *
Your answer
Postcode / Zip code *
Your answer
Stad / City *
Your answer
Ben je geïnteresseerd om actief lid te worden? / Are you interested in becoming an active member? *
IBAN rekeningnummer / IBAN account number *
In case you have a non-Dutch account, please include your BIC number.
Your answer
Accounthouder / Account holder *
De naam van de eigenaar van de pinpas. / The name of the owner of the bankcard.
Your answer
Ik geef hierbij toestemming aan de Treasurer van ELSA Groningen om 10 euro af te schrijven per academisch jaar. / I hereby agree to the payment of 10 euro per academic year taken out of my account by the Treasurer of ELSA Groningen. *
Als je je wilt uitschrijven dient dit voor de eerste september te geschieden. / If you want to sign out you have to sign out before the 1st of September.
Required
Wanneer er iets verandert stuur ik de veranderingen op naar de Secretaris Generaal van ELSA Groningen voor een complete database van onze leden. / When anything changes I will send the changes to the Secretary General of ELSA Groningen for a complete database of our members. *
Required
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