Nationale Opera & Ballet - Sign up as Fellow

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1. Declaration of Donation

The undersigned hereby declares they will make a donation and support Dutch National Opera & Ballet Fonds in the role of:

Fellow: Donations of €1000 a year

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3. Personal information

Lastname *

Gender *

Female

Male

Firstnames (full) * Day of birth * Place of birth *

Street *

Housenumber *

Addition

Postal code *

City *

Country * Telephone * Email address *

Do you want to share your membership? Your membership to the Young Patrons Circle is valid for two persons! If you want to share your membership with someone else, please fill in his/her details below.

Yes No

Details of partner

Lastname *

Gender *

Female *

Male

Firstnames (full) * Day of birth * Place of birth *

Street *

Housenumber *

Addition

Postal code *

City *

Country* Telephone *

Acknowledgement

Yes, I would like my name to appear in Dutch National Opera & Ballet publications

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Sign up as Fellow

1. Declaration of Donation

2. Duration of the donation

3. Personal information

Details of partner

Acknowledgement

4. How will you pay your gift

5. Check and details of organization

Details of organisation