Become a member

Amazing that you want to become part of Dispuut Verkeer. Filling in this form is the first step.

The annual contribution for Student and Alumni members is € 5, which will be deducted directly from your account annualy.

Fields marked with an asterisk (*) are mandatory.

Who are you?Firstname *
Lastname *
Initials *
Please add a picture of yourself *
Date of birth *
How do you identify? *

Where do you live?Street + house number *
ZIP-code *
City *
Country *
I prefer to receive the association Fly-Over magazine in paper at my home address (the Fly-Over will always be available for all members digitally).

What are you studying?Which program are you or have you studied? *
When do you or did you start your program? *
What is your student number? *
Please select a membership: *

How can we contact you?What is your phone number? *
What is your email? *

PayingWhat is your IBAN? *
What is your BIC?

OtherI agree and consent to the storage and use of the information I have provided through this form by Dispuut Verkeer, subject to the Internal Regulations of Dispuut Verkeer. *
I authorize Dispuut Verkeer to withdraw the yearly contribution along with any other costs for activities I sign up for from my bank account until I terminate my membership. *

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