Centuria Study Association - Membership Application Form

Centuria Study Association

Membership Application Form
Name *

First Name Last Name
(Student) Email *
studentnumber@student.hhs.nl
Phone Number (optional)

Area Code Phone Number
Student Number
Required for current students only
Are you an SSMS Alumni?
Alumni can provide their personal email addresses
Do you consent to be notified on upcoming Centuria Events? *

Yes
Through which media(s) of communication would you prefer to be notified? *

Centuria Facebook Page Email Centuria Website Face-to-Face (only for current SSMS students) Other - please explain
Do you consent to having your pictures taken at Centuria Events? *
Do you consent to have your picture(s) Uploaded on our social media platforms? *
All pictures are screened for lewd and inappropriate behavior prior to publication.
If you chose "Other", kindly elaborate.
Choose type of membership *
(Solely for hooded/dressed Centurion memberships) I would like my t-shirt/hoodie in size:
Yearly Membership Fee Details (renewable upon re-submission of application form).

Membership Fee: depends on type of membership
IBAN: NL91 RABO 0311 3655 07
Name: Centuria Association
Description of Transfer: *Your student number* - Centuria Membership

Your membership will be valid once the membership fee has been paid.
I would like to pay by *
I have read and understood the payment details stipulated here. *

Yes, and I will transfer the membership fee to complete my subscription.
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