CCN Member Registration Form

First name

Initials

Middlename

Noble and/or academic title

Surname*

Gender

Position

Date of commencement of position

Represented country

Walk area in NL

Retired (Buiten dienst)

If so, since when?

Consulate details

Telephone number

Second phone number

Mobile phone number

Mobile phone number private

Email address for correspondence*

Second email address

Website of Consulate

Working for company/organisation/etc.

Website of company/organisation/etc.

Address for correspondence

Consulate name

Postal address

Postal house number

Postal code

City

Country

Visiting Address

Street name

House number

Add house number

Postal code

City

Country

Building

Extra information

We would like to receive a picture of you in the style of a passport photo for our membership list. Preferably a file of 250K to 1 megabyte:jpg, word (doc/docx) or pdf. Maximum size: 1,5 megabyte.

You can upload it here or send it by email, stating your name.

The CCN secretariat automatically stores this information in its database.

Profile image

Privacy statement

I agree with the Privacy statement*

Date agreement Privacy statement*

Please send a proof of your appointment to tairaterces.[antispam].@ccnederland.eu

Check*

Submit

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Contact information

secretariat.[antispam].@ccnederland.eu

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