Alumni Event-in-a-Box - Registration form

Motivation

I would like to host drinks for Utrecht University alumni in my city because….*
(max 350 characters) *

Personal information

First name *

Prefix

Last name *

Title

Address line 1

Address line 2

Postal code

City

Country *

State (USA)

Email address *

Phone number

The event

City *

Country *

Proposed date
(at least 2,5 months
later then date of
completing form)

Proposed time

Proposed location

Address for the box to be send to

The box can be sent to the address listed above *

Yes

No

Please list another address

Address line 1

Address line 2

Postal code

City

Country

Comments and/or Suggestions

Is there anything else you would like to share?

* = Input is required