Lokaal Brabant | Word lid

MELD JE AAN

Word vandaag nog lid van Lokaal Brabant. Al vanaf een jaarbedrag van €25,- kunt u ons steunen.

Dit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.

Naam(Vereist)

Voornaam Achternaam

E-mailadres(Vereist)

Wilt u onze nieuwsbrief ontvangen?(Vereist)

Nee

Wilt u zich aanmelden als vrijwilliger bij activiteiten?(Vereist)

Nee

Wij zullen dan contact met u opnemen.

Telefoon

Adres

Straat + huisnummer Plaats Staat / provincie / regio Postcode Land

Toestemming

Ondergetekende verklaart op de hoogte te zijn van het feit dat lidmaatschap van Lokaal Brabant tevens gelijk staat aan lidmaatschap van Onafhankelijke Politiek Nederland (OPNL).

Ik ben akkoord met de € 25,00 lidmaatschapskosten per jaar.

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