Benefactor registration form

Please complete the form below to become a benefactor of Japie. You will then receive further instructions on how to finalise your benefactorship.

Note: If you already have an account on this website (e.g. because you are a member of Japie, or you were a member of Japie in the last 2 years), please sign in to your account and then come back to this registration form. You can keep using your existing account as a benefactor. If you do not already have an account, continue filling in the form.

First name

Affix

Last name

Email address

Phone number

Gender

Birthday

Street name, number

Postal code

City

Country

I would like to receive the Japie newsletter.

T-Licht (association magazine) delivery

I would like to receive mail from Japie.

I authorize Japie to directly withdraw the money from my bank account.

Password

Confirm password

I have read and I accept the privacy policy.