Lidmaatschap

First name *

Last name *

Street name + number *

Zipcode *

City *

Mail address *

Date of birth *

Mobile number *

Bank account (IBAN) *

Emergency number *

Educational institute

Student number

NKBV membership nummer

Customer number Sports Center (Important, this will be used for subsidy at the Sports Center)

I declare that TilSAC can use my customer number from the Sports Center

House rules (https://tilsac.nl/huishoudelijk-reglement/) and Privacy (https://tilsac.nl/privacybeleid/) * I hereby declare by means of my signature that I have taken knowledge of and agree with the terms and conditions of TilSAC *

I authorize TilSAC to continuously debit the yearly contribution (established by the ALV) from the bank (IBAN) account mentioned above *

In addition, I declare that if I participate in TilSAC activities, it will be at my own risk. Also, I declare that I have arranged a valid insurance for any risks or harm during climbing which will cover my own risks, but also cover any accident caused by myself (material, physical or mental damage). Finally, I can in no way hold the association or the board members accountable or make claims regarding any injury, damage and loss occurred during any TilSAC related events. *

Contribution *

• Contribution academic year 2021 - 2022 (€ 22,00)

Amount *
€

Payment method *

• iDEAL (+ € 0.29)
• Overboeking (+ € 0.45)

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