Personal data
Surname*Prefix
Firstname*Initials *
Date of birth* * * *
Place of birthPlace of birth NationalityNationality
Country*
Zip code*House number *
StreetCity
Telephone*Mobile
Email
[emailhelp]
*
Passport-style photo (headshot)
Max. 8 MB. Dimensions min. 300 x 400 px. Different dimensions will be cropped to the middle of the picture.
Questions
Extra details
In case of emergency, telephone number
Duration of membership
If the duration of your membership is limited, enter the desired end date of your membership.
 
Ultimate history
Played at another club
Name previous club
 
Statutes, terms and conditions
*By ticking the attached checkbox you indicate that you have taken note of the statutes and the terms and conditions of Panic.
 
Personal data
Your data will not be shared with third parties for commercial use.
If this does happen, permission will be requested in advance.
However, if necessary, relevant data will be exchanged with third parties that are necessary for membership-related matters.
Agreement is required before entering into membership.
*I agree
 
Footage (GDPR, AVG)
Whilst being a member of Panic, footage can be made during practices or events to be used for promotional purposes.
I may withdraw my consent at any time. In this case, I will inform the board of my choice.
During such events, the social media committee will inform me of footage being taken on a case-by-case basis.
*I consent
*I do not consent
 
High/low contribution
As Panic, we want to make sure that we are affordable for everyone. Therefore, we're introducting a slightly tiered contribution system. Currently, Panic membership is €85, and NFB membership is €37.
With the tiered system, we will introduce a €20 discount for students and others who might not be able to afford the full membership fee.
This is an honorary system. We are not going to check if you actually meet the conditions. That does mean we expect you to fill it in truthfully, and we also expect you to contact us once you are able to afford the full fee.
I wish to apply for the low contribution fee.
You will pay €65 for Panic on a yearly basis instead of €85. The NFB membership will not change in cost.
Expected end date (leave empty if unknown)
 
I have answered the above truthfully and will contact Panic when my situation changes
Yes
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