Please fill in this form to complete your membership! An email with information for new members will be send to you in 7 days. All fields are required.

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Your First name and Last name

Your Full name according to your passport

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Your Email

Your Address and house number

Your Postal code (example: 4545 AB)

Your City

Your Phone number (example: +316-12345678)

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Your Date of birth

Your Place of birth

Your Nationality

Your Gender:
 Man Woman

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I'm Interested in the following Committee:
---AEGEE-Tilburg Summer University CommitteeAEGEE-Tilburg Exchange CommitteeAEGEE-Tilburg Activity CommitteeAEGEE-Tilburg Audit CommissionA European CommissionA European CommitteeA European Working GroupOtherNone

Your Previous experience with AEGEE or an other organisation:

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What type of membership do you want?
European Membership (15,- per year)

Your Dutch* bank account number (example: 1212.22.121)

I hereby authorize AEGEE-Tilburg to withdraw 15 euro membership fee from the above mentioned bank account.

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