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?

    Are you following a bachelor or master course?

    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.