Application form for the Fan Club of Monika Martin.

Your Name …………………………………………………………………………………….

Your first name and for a family membership the name of your Partner:

…………………………………………………………………………………….

Your Date of Birth and for a family membership the Date of Birth of your Partner:

…………………………………………………………………………………….

Street…………………………………………………………………………………….

Post code …………………………………………………………………………………….

City/Town ……………………………………………………………………………………….

Telephone number ……………………………………………………………………………………….

Your E-mail address and for a family membership the e-mail address of your partner:

……………………………………………………………………………………….

You are able to cancel this membership after a full year with a notice of a minimum of 3 Months. If you do not cancel, or cancel too late then your membership will run for a further full year with the necessary payments.

Date …………………………………….

Signature ………………………………….

O Membership fee of € 22.00 a Year I will include in this envelope (Membership fee for 1 person)

O Membership fee of € 22.00 a Year I will transfer to the account below (Membership fee for 1 person)

O Membership fee of € 29.00 a Year I will include in this envelope (Family Membership fee for people at the same address only)

O Membership fee of € 29.00 a Year I will transfer to the account below (Family Membership fee for people at the same address only)

If you decide to become a Member in the 2nd quarter of the Year, then your fee will be 3/4 of the Membership fee (€ 16.50 or € 21.75).
If you decide to become a Member in the 3rd quarter of the Year, then your fee will be the 1/2 of the Membership fee (€ 11.00 or € 14.50) and if you decide to become a Member in the last quarter of the Year, then your fee will be 1/4 of the Membership fee (€ 5.50 or € 7.25).

We are sorry not to be able to send you our latest edition of our fan club magazine if you make use of our discount rules.
If you would still like to receive our latest edition of our fan club magazine then you should pay a further extra quarter.

You can pay your membership to:
ABN/AMRO 61.99.66.149
IBAN: NL71ABNA0619966149
BIC code: ABNANL2A

Fao R. de Bondt
Schweitzerstraat 58
1433 AH Kudelstaart
The Netherlands

From now on it is also possible to pay your contribution through Paypal.
Go to www.paypal.com

The only thing you need to do next is register.
From your account you can book your membership fee through to fanclub@monika-martin.nl
There are no additional costs with this way of payment.
We think this may be a good alternative because some members do face additional costs.

If you decide to send cash money then you should send this to the address on the top of this letter.

WARNING! : THE REGISTRATION FORM SHOULD IN ALL CASES BE SENT TO OUR HEADQUARTERS IN THE NETHERLANDS.