Membership registration form - Domstad Devils

Naam *

Voornaam

Achternaam

Date of birth *

DD/MM/YYYY

Address *

Street name + number

Postal code *

City *

Country *

Phone number *

land code: please use 00 instead of ‘+’ e.g. the Netherlands will be 0031 (Not +31)

E-mail *

E-mail

E-mailadres bevestigen

Are you a student at the UU or HU? Students receive a discount on a Full membership. Proof of registration needs to be sent to secretary@domstaddevils.nl. *

Yes
No

Type of membership *

By checking the box below you agree to pay the membership fees *

I agree

By checking this button below, I agree to the articles of association and the internal regulations. *

I agree