‘FRIENDS OF THE OBRECHTKERK’ APPLICATION FORM

First name

Surname *

E-mail address *

Membership type *
Premium, 1,000 euros a yearFamily, minimum two people, 175 euros a yearIndividual, 100 euros a year

Phone number

Street and house number

Postal code and town

I would like to contribute by automatic transfer until further notice of cancellation. Please get in touch with me.

Please keep me informed of any news and developments.

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