HCSA Pisa & Florence Trip Sign-up
Registration for those wishing to attend the HCSA trip to Pisa & Florence from May 4th to May 7th.

Please note that by signing this form you are agree to the HCSA withdrawing the full amount of €230 for HCSA members, €255 for non-HCSA members from your bank account. The trip fare includes:

- Flight fare
- Train fare from Pisa to Florence and back
- Hostel stays
- Breakfast
- An organized cultural activity
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Email *
What is your student number? *
Are you an HCSA member? *
Please note: if you are not an HCSA member you will be placed on a waiting list and you will pay €255 instead of €230. If you are registering as a 'buddy' of an HCSA member, you will not be wait-listed but will still pay the non-HCSA member price.  
If you are registering as a 'buddy' of an HCSA member, please state their name here.
First Name (as stated on passport) *
Middle Name
Surname *
Gender *
Date of Birth *
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DD
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Passport Number/ID Card (Please indicate whether the number you have given is for passport or ID) *
Nationality *
Do you require a visa? If so, this must be arranged yourself. *
Please indicate if you would like to make use of our group ticket for the train trip from Groningen to Eindhoven Airport and back. *
The group ticket will cost approximately €6 - 8 for one way and is not included in the price of the HCSA trip. If you would like to make use of the group ticket (or buy your own ticket) you can travel with a larger group from Groningen to Eindhoven airport. If you will make your own travel arrangements you will need to arrive at Eindhoven Airport by 12 PM. Further exact details will follow.
During our flight with RyanAir, only a small piece of cabin luggage is included in the price (max 40x20x25 cm which must fit under your seat). Please indicate if you would like to pay an extra €6 to be allowed one larger bag or suitcase to be put in the overhead compartments of the plane. *
Please find out more about RyanAir's rules for luggage here: https://www.ryanair.com/gb/en/useful-info/help-centre/faq-overview/Baggage#0-0
Phone number *
Please provide your IBAN and name on your card *
Additional info that you think we need to know:
i.e. allergies or other dietary requirements etc.
Do you agree with the following terms?* *
Required
*By sending this form I authorize the HCSA to initiate debit entries to my checking account at the financial institution listed above, for the collection of premiums on the policy specified, that is €230 for members and €255 for non-members of the HCSA (excluding the fee for the optional train ticket and extra luggage) around the 25th of April 2019. Because of the nature of the activity and the corresponding obligations to external parties, it is not possible to cancel your registration. If you cancel your enrollment, you will still need to pay the full amount as listed above.
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