I would like to join the Scotch Malt Whisky Society Benelux branch. The annual fee is NLG 160, BEF 3030 or DEM 142, this includes an introductory bottle of single malt whisky.
Thereafter subscriptions are renewable, for NLG 60, BEF 1135 or DEM 54, on the anniversary of joining.

Name:

Address:

City/Town:

Postcode:

Daytime Telephone:

Fax:

Sex:

Prefered language:

Method of Payment (tick appropriate box):

Bank-transfer for Germany ABN/AMRO Düsseldorf N° 14.32.664/018. Bankleitzahl N° 301 204 00 (DM)

Bank-transfer for The Netherlands ABN/AMRO N° 46.25.27.700 (NLG)

Bank-transfer for Belgium BBL N° 310.1190885 .05 (BEF)

A guaranteed, complete filled in and crossed Eurocheque in Dutch Guilders. (Please, do not forget your bank pass-number!)

Giro Betaalkaart

Diners Club (NLG)

American Express (NLG)

Visa (NLG)

Euro Mastercard (NLG)

Card Number:

Expiration Date:

Certification: I am 18 years of age or over.

Place & Date:

Signature:

Please make cheques payable to The Scotch Malt Whisky Society and send to: The Scotch Malt Whisky Society, Vijfhuizenberg 103, postbus 1812 4700 BV Roosendaal, The Netherlands.
Telephone: +31 (0)165 529905
Facsimilie: +31 (0)165 540067