Registration form

This form is for the registration of your donation to the Helene Kröller-Müller Fund.

I declare hereby to donate a amount to the Helene Kröller-Müller Fund: *

Bronze booker €5,000.00 *

Silver booker € 12,500.00 *

Gulden booker € 25,000.00 *

Donation method *

I opt for a one-time donation. I receive a payment request. *

I opt for a periodic donation, whereby I pay the chosen amount in 5 equal installments over 5 years. I receive an annual payment request. *

Attribution: *

I want to be reffered on the sponsorboard in the museum and on the website *

Yes, first and last name *

Yes, together with my parnter (first and last name) *

No, I want to stay anonymous *

Please enter your details here
If you donate together with your partner, please fill in the requested information for both of you. If your partner is not a co-donor, you do not need to fill in the details. However, your partner must give permission for the donation in accordance with Article 1:88 of the Civil Code and sign this form.

First name *

Middle name

Surname *

Salutation *

Street name *

House number *

Zip/Postal code *

Zipcode notation: 1234AB

City *

Telephone number *

Mobile number

E-mail address *

Birthday *

Married/registered partner with:

Do you have a funding partner?

First name *

Middle name

Surname *

Birthday *

Signature donor *

Signature partner

Our privacy policy sets out how we process your personal data.