Your first and last name *
Your email *
Your gender *Male Female
Your city of residence *
I am an international student
Your country of origin if checked statement above
Your (past) educational instution *
Your field of study or profession *
Membership Fee (€ 15,00 per year)
I acknowledge that my membership is only valid in the current academic year, which ends on July 31st, unless it is renewed in the following academic year starting August 1st.
By filling in this form you grant permission to Student Association Salaam to collect the membership fee of 15,- annually by direct debit. Your membership will be renewed every year. If you want to terminate your membership you can do this by sending an email to firstname.lastname@example.org until July 1 of the academic year.
Also I give permission to email (about events, and other important things) me. (We will not spam you, we promise)
Payment method *
I hereby give authorization to collect the recurring amount from my account periodically.