Membership Application

Username:

{{ form.username.data }}

E-Mail:

{{ form.email.data }}

Full Name:

{{ form.fullname.data }}

Birthday:

{{ form.birthday.data }}

Street:

{{ form.street.data if form.street.data else "Not specified"|safe }}

ZIP-Code:

{{ form.zip.data if form.zip.data else "Not specified"|safe }}

City:

{{ form.city.data if form.city.data else "Not specified"|safe }}

State/County/Province:

{{ form.state.data if form.state.data else "Not specified"|safe }}

Country:

{{ form.country.data if form.country.data else "Not specified"|safe }}

Membership Plan:

{{ form.membership.data }}

Student:

{{ "Yes" if form.student.data else "No" }}

Starving:

{{ "Yes" if form.starving.data else "No" }}

Payment:

{{ form.payment.data }}

Agreed to Terms & Conditions:

{{ "Yes" if form.terms.data else "No" }}

Minor Member:

{{ "Yes" if form.minor_member.data else "No" }}

GPG-ID:

{{ form.gpg.data or "Not specified"|safe }}

Jabber Handle:

{{ form.jabber.data or "Not specified"|safe }}

Twitter Handle:

{{ form.twitter.data or "Not specified"|safe }}

Send this document to the Chaos Computer Club Lëtzebuerg!

• Account Holder: Chaos Computer Club Lëtzebuerg
• BIC/Swift: BCEELULLXXX
• IBAN: LU29 0019 2855 3890 4000
• Message: Membership fee {{ year }} {{ form.username.data }}
• Amount: {{ price }}€

Please bring {{ price }}€ with you the next time you meet us!

• Address: 3BV5UPToMUmXJiqUVndHjSSq2HqDW8npRd
• Label: Membership Fee
• Message: {{ year }} {{ form.username.data }}
• Amount: {{ price }} BTC

{% set bitcoin_url= 'bitcoin:3BV5UPToMUmXJiqUVndHjSSq2HqDW8npRd?amount={amount}&label=Membership Fee {year} {username}&message=Membership Fee {year} {username}'.format(amount=price, year=year, username=form.username.data) %}

• Address: 0x1C05b4C236914B218B57e0E25948d416B4885655
• Label: Membership Fee
• Message: {{ year }} {{ form.username.data }}
• Amount: {{ price }} ETH

{% set ethereum_url= '0x1C05b4C236914B218B57e0E25948d416B4885655' %}

{% set digicash_url='https://pos.digica.sh/qrcode/generator?merchantId=CHAOSPC1&amount={amount}&transactionReference=Membership_{username}'.format(amount=price, username=form.username.data) %}