ClubCollect

Vereniging voor Netwerkcultuur

Personal Details

To protect the privacy of minors (people under the age of 18) please consider entering only their initials instead of their full first name.

Title

Initials

First Name (required)

Infix

Last Name (required)

Date of Birth

Contact Details

Contact Email (required)

Phone 1

Country Code (required)

Phone Number

Find Address

Type in some of your address details to locate your address

Address line 1 (required)

House No. *

Extension

Address line 2

Postcode (required)

City (required)

Country

Payment Details

Payment Type

Yes, I agree with an automatic bank transfer of 12 euros per 3 months until written cancellation

INC membership contributions are collected using automatic bank transfers. Automatic bank transfers of 12 euros are initiated four times per year: on 1 January, 1 April, 1 July, and 1 October.

IBAN (required)

I am the bank account holder or custodian.
By signing this mandate form, you authorise (A) ClubCollect to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from ClubCollect. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited.

Other Details

Type of Membership (Subscription/Plan) (required)

Additional Info