Contact Form

This form can be used to contact the Foundation, to apply for membership or to donate funds.

 

The annual membership dues are € 25. If at all possible, please have the funds transferred automatically to our bank account in Holland:

 

NEDERLAND
RABO bank, rekeningnummer: 1140.67.570

ten name van: Buijyvoets te Heemstede

IBAN: NL39 RABO 011 40 67 570

 

If you pay by personal cheque we will run up significant bank charges. If that is the only feasible method of payment for you, we would ask that you add €10, to partially offset those charges.

 

 I wish to apply for membership of the Foundation and will transfer €25 or its equivalent to your bank account
I wish to apply for membership of the Foundation and will send you a cheque for € 35 or its equivalent
I wish to become a benefactor of the Foundation and will donate the amount of  €   to the Foundation


I have the following question(s) and/or comment(s):

 

Last Name
First and Middle Names:

Name you usually go by:

(e.g. Bill for William etc.)
Street Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone number:
E-mail address:

                     

©-2003 Jan Buyvoets - laatste wijziging:      [disclaimer]