Application form Circle

Company(Required)

Name(Required)

Voornaam Achternaam

E-mail address(Required)

Phone number(Required)

Name (business) partner or guest

Voornaam Achternaam

Job title

Postal address

Street Address City ZIP / Postal Code

Visiting Address

Street Address City ZIP / Postal Code

Billing Address(Required)

Street Address City ZIP / Postal Code

Chamber of Commerce number

PO/reference number, if any

Website

Send invitations to events to:

First name Last name

E-mail address

Phone number

Application(Required)

Signing up as a member of the Nieuwe Instituut Circle

Would like to be listed with the following company name on Nieuwe Instituut Circle communications:

Company name

Type of Membership(Required)

Circle sponsor €5.000 per year ex. VAT

Circle member €3.500 per year ex. VAT

Entrepreneur, Startup: €1.000 ex. VAT (contact us for terms and conditions

Want to sponsor more? Please contact us about the possibilities.

Tax Benefits

Membership can be in company name or personal title. Nieuwe Instituut is a public benefit organisation (ANBI). This means that by law Circle membership costs are deductible from the taxable income of both individuals and businesses.

Signature

Place(Required)

Date

Name

Confirmation(Required)

I hereby confirm my application for the Nieuwe Instituut Circle