First name*

Last name*

Street + house number*

Postal code*

City*

Telephone*

E-mail*

Date of birth*

Main interest
Road cyclingCyclocrossMountain biking

I am a student at a university in the Netherlands (Employee, PhD, etc. = No)
YesNo

TU sports card number (if you have one; it is not required)

Membership runs from September 1st through August 31st and will automatically be renewed yearly unless the member requests to be deregistered (before September 1st). The cost of membership is €30,- per year for students, and €50,- per year for non-students (PhD candidates, TU employees, etc.).

IBAN* (zonder spaties)

Name as shown on bank card*

I authorize WTOS to annually withdraw the membership fees from the account shown above until I deregister by email*

I agree with the WTOS privacy policy linked at the bottom of this page*