Application form student membership

We are very pleased that you would like to join the Dutch Association of Psychologists (Nederlands Instituut van Psychologen, NIP). With this membership you will enjoy several benefits at a reduced rate: only € 25,-. Please fill in your details below and we will process your request as soon as possible.

1. Personal information

Honourific*

Firstname*

Initials*

Surname*

Title (optional)

Date of birth*

Place of birth*

Address*

Zip code*

City*

Phone number*

E-mail address*

2. Study details

University*

Date of bachelor exam

Expected date of graduation*

Specialization

3. Declaration on Code of Ethics

" I declare that in the performance of my activities as a psychologist I shall be guided by the professional code for psychologists as described in the Professional Code of Ethics for Psychologists. I also declare that if complaints are made to NIP about my practice or my attitude as a psychologist I shall submit to an investigation by the supervisory Boards.”

Yes, I agree

4. Declaration on the provision of personal information

NIP is allowed to provide my personal information to third parties for sending information.

5. Membership commencement date/ Payment method of contribution

Your membership is effective from the first of the month. Please indicate below when you wish to commence your membership.

Single payment is only possible by debit authorization. Collection date is January 1st.

I have taken note of the fact that if I wish to terminate my membership I must give notice in writing before 1 December of the year prior to the year in question. The undersigned declares that he/she agrees to the payment arrangements as set out above.

Yes, I have read and taken notice of all of the above.

6. Additional information

Proof of registration as psychology student or Master's student Mental Health (One required):

Photograph or scan of official proof of registration *
Photograph or scan of student card stating ‘study psychology’
Print Screen of Studielink

For students of the Open University:

Photo or scan of the course registration

Please note when submitting a photograph, the data should be clear and legible.

* Proof of registration will be emailed to you by Studielink (among others). By searching for ‘proof of registration ' in your email you will find this document. If you send this email in an attachment when registering as a student member, this is sufficient evidence to prove that you're a psychology student .

Any questions and/or comments

Any questions and/or comments

7. Permission debit dues NIP

You consent to the Dutch Institute of Psychologists (NIP) to send a continuous debit to your bank to debit the membership fee from your account. If you do not agree with this depreciation, you can ask for a reversal at your bank. To do so, contact your bank within eight weeks of depreciation. Ask your bank for the exact conditions.

IBAN*

Bank Identification (BIC)

Student Membership