Focus - Purchase membership card

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Fill out the form below and click 'Next'.

Card type

Sex

Male

Female

Other

I'd rather not say

Birth date

Initials

First name

Middle initials

Last name

Zip

Address line 1 (number)

Address line 2

Address line 3 (street address)

City

Email address

Confirm email address

Phone number

reeks_label

reeks_boekenfilm_label

Photo

Upload a recent photograph for your membership card. Only images in JPG format are allowed.

Direct debit?

Nee

	SEPA Core Direct Debit
	You must pay the membership fee for the first year now. The mandate is used to renew your membership card on the due date.
IBAN	Enter IBAN to use for this mandate.
Account name	Name associated with bank account for this mandate.
	By signing this mandate form, you authorise Focus Filmtheater Arnhem to send instructions to your bank to debit your account and authorise your bank to debit your account in accordance with the instructions from Focus Filmtheater Arnhem. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited.

Continue to confirmation page.