Filmhuis Bussum - Purchase membership card

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Purchase membership card

Fill out the form below and click 'Next'.

Amount

Sex

Man

Vrouw

Birth date

Initials

First name

Middle initials

Last name

Zip

Address line 1

Address line 2

Address line 3

City

Email address

Confirm email address

Phone number

Wekelijkse nieuwsbrief

	Ja; zo word ik op de hoogte gehouden van de laatste nieuwtjes en het filmprogramma van de komende week
	Nee; daar stel ik geen prijs op

Photo

Upload a recent photograph for your membership card.

Direct debit?

	SEPA Core Direct Debit
	You must pay the membership fee for the first year now. The mandate is used to renew your membership card on the due date.
IBAN	Enter IBAN to use for this mandate.
Account name	Name associated with bank account for this mandate.
	By signing this mandate form, you authorise Filmhuis Bussum to send instructions to your bank to debit your account and authorise your bank to debit your account in accordance with the instructions from Filmhuis Bussum. 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.

Continue to confirmation page.