Punch administration:
Algemeen
Competitie
 Pasfoto  Leden DB
 Schuldvrij  Ref. diploma
 ISS
 Spelerskaart
:
:
PUNCH Basketball
D e l f ts e
S tu de n te n
Ba sk e tb a l l
Ve re ni gin g
Membership Form
Read this form carefully and fill it in as completely as possible. Please use block letters.
Personal information:
Name:
………………………………………………
Initials:
……………………………
First Name:
………………………………………………
Gender:
 Male
Date of Birth:
………………………………………………
Birthplace:
……………………………
Adres :
………………………………………………
House nr:
…………………………………….
Zipcode:
………………………………………………
City:
……………………………………
Phone number:
………………………………………………
Mobile:
……………………………………
E-mail:
………………………………………………………………………………………………………
Student?
 No
Where?
………………………………………………
Sports card nr:
………………………………………………
Former team:
………………………………………………
 Yes
 Female
Study:
……………………………………
Student
Nr:
……………………………………
City:
……………………………………
Alternative adres: ………………………………………………………………………………………………………
Zipcode:
………… ……
Phonenumber:
………………………………………………
City:
……………………………………
Check the appropriate box:
 I would like to become a training only member.
 I would like to become a competitive member. Fill in this box:
Have you been a member of another league club in Europe in the last five years?
 No I have not. Please sign here to confirm this: ………………………………
 Yes: obtain a debt free declaration so you can become registered in the Dutch league. Ask for this from your previous
club.
What level have you played at?
 National
 Local
 Regional
 I’m a streetballer
Do you own a referee’s diploma?
 No
 Yes, I’m,
 F-licensed
 different, namely …………………………………
 E-licensed
 D-licensed
 foreign diploma
Do you have a preference for a team?
 No
 Yes, I’d like to play in the …… team
(See other side)
D.S.B.V. Punch
Postadres: Punch Basketball, Sportcentrum TU Delft, Mekelweg 8, 2628 CD Delft
ABN-AMRO NL78ABNA 55.46.72.995 BIC: ABNANL2A KvK: 40398221
www.Punch-Basketball.nl info@Punch-Basketball.nl
PUNCH Basketball
D e l f ts e
S tu de n te n
Ba sk e tb a l l
Ve re ni gin g
(resumed from front side)
We are always looking for enthusiastic new members to (help) organize all sorts of fun activities.
 Yes, I would like to help with:
 Website
 Punch club letter
 Parties
 Tournaments
 Other events (eg ski/summer trips, gala etc), namely:
………………………………………………………………………….
 No, I’m not interested in helping out.
I would like to pay my membership fee by the following means:
Membership costs €46 for training members and €108-150.50 (level dependent) for competitive. In addition the uniform input
consists of €11.50 for every competitive member.
Each competitive member has to pay €25 extra per year if he/she does not have his/her F-diploma. This €25 will be returned if
he/she joins an F-referee course, or is willing to join one, but cannot due to overcapacity of the referee course.
Furthermore, if you’re not a student (anymore) at the TU Delft or any other college/university, €25 will be added to your
subscription fees.
I give you transfer rights (Dutch bank accounts only. Please fill in the segment below). If this is not possible,
please contact the board.
I hereby grant D.S.B.V. PUNCH the right to withdraw my yearly membership fee from my account until such time
as I end my membership with the club.
I choose:
 Single payment, (October)
 2 term payment, (October and January)
IBAN:
…………………………
Name account holder:
………………………………………………………
Place of residence (account holder):
………………………………………
Important to know:
-
The season runs from 1st August to 31st July.
You are required to obtain a sports card for the TU sports center.
You are required to pay your yearly membership fee.
Your membership continues until such time as you end it.
If you are going to play competition, you are obliged to do tasks before or after your game. This is either a table task of refereeing.
If you are going to play competition, you are also obliged to get a refereeing diploma. The course will be provided by Punch.
Cancellation or change of your membership must be performed in written form before the 1st of May to the Board of D.S.B.V.
Punch.
For changes and cancellation please email secretaris@punch-basketball.nl
Filled it all in?
Please hand this form in to a member of the board or send it to the address at the bottom of this page. Please also supply:
One recent passport photo. Digital is also okay, email to secretaris@punch-basketball.nl
A release form from your former club (If applicable).
A copy of your referee’s diploma (If applicable).
For more information: www.punch-basketball.nl or email info@punch-basketball.nl
By signing this document I declare that I have filled it in completely and truthfully.
Date: ...............................................
Signature:
Place: ................................................
...........................................
D.S.B.V. Punch
Postadres: Punch Basketball, Sportcentrum TU Delft, Mekelweg 8, 2628 CD Delft
ABN-AMRO NL78ABNA 55.46.72.995 BIC: ABNANL2A KvK: 40398221
www.Punch-Basketball.nl info@Punch-Basketball.nl