Become a member of Sirius A
S- or P-number*
S- or P-number*
First name* / Prefix / Last name*
First name*
Prefix
Last name*
Date of birth*
Date of birth*
Januari2000
MaDiWoDoVrZaZo
272829303112
3456789
10111213141516
17181920212223
24252627282930
31123456
Phone number*
Phone number*
Current Study*
Current Study*
Email*
Email*
Street name* / House number* / Addition
Street name*
House number*
Addition
City*
City*
Postal code*
SEPA direct debit mandate

By signing this mandate, you authorise (A) 'Sirius A - Study Association Astronomy' (Creditor ID:
NL84ZZZ686923660000) to send instructions to your bank to debit your account and (B) your bank to debit your
account in accordance with instructions from 'Sirius A - Study Association Astronomy'. These debits include the
yearly contribution of €10 and any expenses incurred through your membership of Sirius A, such as event or food
costs, not collected via other methods. 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. Your rights are explained in a statement that you can obtain from your
bank. 

By clicking this box I agree with what is stated above*
By clicking this box I agree with what is stated above*
Next to the costs stated above, I would like to make a one time donation of:
Donation (in €)
Donation (in €)
IBAN*/ BIC**

Account holder*:

IBAN*/ BIC**

Account holder*:

IBAN: BIC:
t.n.v.:
** Please fill in your BIC by hand if you have an international account
Is there anything else you want us to know?:
Notes
Notes