Sign-up form Active Member Weekend 2023

Fields marked with an asterisk (*) are mandatory.

Personal informationName + Surname *
Email *
Phone number *
Street + house number *
Postal code *
City *
Country *
Committee *
Student number *

Dietary restrictionsDo you have any allergies or dietary restrictions?

Authorization

Undersigned authorizes the VSPVU to credit a one-time MAXIMUM amount of EUR 48, from the below mentioned account number (3).

(1) Because of the legislation, the creditor (VSPVU) needs the IBAN number of the undersigned. On www.ibanbicservice.nl, a Dutch account number can be turned into an IBAN number.

(2) Not a mandatory field if you have a Dutch IBAN.

(3) The money will be charged from your bank account latest two weeks after the event took place.

Name account holder *
IBAN number (1) *
Bank identification (BIC) (2)
I agree that the Treasurer of the 76th Board of the VSPVU will withdraw a maximum amount of EUR 48 from my bank account for an Active Member Weekend 2023 ticket. *

Sign-up form Active Member Weekend 2023

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