Active Member Hoodie

Fields marked with an asterisk (*) are mandatory.

Personal InformationName + Surname *
Name you want on the hoodie (no offensive things) *
Committee *
Function *
Phone number *
E-mail *
Size hoodie *

Authorization

Name account holder *
IBAN number *
Bank identification (BIC) - not mandatory for a Dutch IBAN
I hereby agree that I authorize the creditor to credit a one-time MAXIMUM amount of EUR 20 from the above-mentioned account number, in response to the VSPVU *

Confirm not a robot

Please complete the expression to confirm you are not a robot, and use digits when answering.