First name

Surname

Date of birth (dd/mm/yyyy)

Adress

Zip code & city

Phone

Your Email

University

Studentnumber

Are you a Dutch or International student?

Would you like to take part in a committee

Full name account holder

Bank account (IBAN)

BIC

Bank & City

Hereby I become a member of ELSA Amsterdam and authorize ELSA Amsterdam to automatically debit my account for a yearly 15 euro-fee until I cancel my membership. This has to be done one month before the end of the academic year either by email or by letter. For exchange students its also possible to pay cash.