ClubCollect

First Name

Infix

Last Name (required)

Gender (required)

Male

Female

Rather not say

Student number

Enter your full student number starting with an 'i' here.

Contact Email (required)

Payment Type

Automatische incasso

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.

Type of Membership (Subscription/Plan) (required)

Which bachelor’s degree did you pursue? (required)