Registration form Archaeopteryx
Yalelaan 1
3584CL Utrecht
First name + last name:*
Student number (if applicable):
Address (streetname + house number):*
Zip code:*
City:*
Country:*
E-mail address:*
Phone number:*
Privacy Policy:*
I give permission to manage and use my data as described in the Privacy Policy.
Statutes and house rules:*
I agree to act according to the statutes and house rules as accessible on our website.
Receiving newsletters and magazines:
I want to receive the AV (Archaeopteryx Veterinaris) digitally. Do not select this option if you want to receive the AV by post. If so, please send an e-mail to secretaris@archaeopteryx-online.com
I want to receive the monthly newsletter.
Continuous SEPA Mandate (Creditor ID: NL25ZZZ404821680000) *
I study veterinary medicine at the faculty of veterinary medicine at Utrecht University. I will pay an annual
I am a student. I will pay an annual contribution of 9 euros.
I am not a student. I will pay an annual contribution of 18 euros.
Name of account holder:*
IBAN bank account number:*
By signing this mandate form, you authorise Archaeopteryx to send instructions to your bank to debit your account fort he contribution and your bank to debit your account in accordance with the instructions from Archaeopteryx. 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 eight weeks starting from the date on which your account was debited. You will remain a member of Archaeopteryx until manual cancellation. Cancellations for the following academic year can be submitted until November 30th of the prior academic year.
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