Duitenberg

Personal Information

Full Name *

Address *

Zip Code *

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Email *

Phone Number *

Student Information

Student Number *

Study *

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Membership Clothing

(Tie/Choker is mandatory at association events)

Tie (€10,00)Choker (€10,00)Bretels (€20,00)

The undersigned wishes to join S.B.V. Duitenberg and hereby authorizes Duitenberg to write off the annual membership fee from his/her account. The regular fee is €25,00. *I have read the above and accept the terms *

Questions or Notes

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Student Information

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Membership Clothing