Membership Application - {{ form.username.data }}

Username:

E-Mail:

Full Name:

Birthday:

Street:

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

ZIP-Code:

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:

Student:

Starving:

Payment:

Agreed to Terms & Conditions:

Minor Member:

Address: {{ config["BITCOIN_ADDRESS"] }}
Label: Membership Fee
Message: {{ year }} {{ form.username.data }}
Amount: {{ price }} BTC

{% set bitcoin_url="bitcoin:" + config["BITCOIN_ADDRESS"] + "?amount={amount}&label=Membership Fee {year} {username}&message=Membership Fee {year} {username}".format(amount=price, year=year, username=form.username.data) %}

Address: {{ config["ETHEREUM_ADDRESS"] }}
Label: Membership Fee
Message: {{ year }} {{ form.username.data }}
Amount: {{ price }} ETH

{% set ethereum_url=config["ETHEREUM_ADDRESS"] %}

Address: {{ config["MONERO_ADDRESS"] }}
Label: Membership Fee
Message: {{ year }} {{ form.username.data }}
Amount: {{ price }} XMR

{% set monero_url=config["MONERO_ADDRESS"] %}

Address: {{ config["ZCASH_ADDRESS"] }}
Label: Membership Fee
Message: {{ year }} {{ form.username.data }}
Amount: {{ price }} ZEC

{% set zcash_url=config["ZCASH_ADDRESS"] %}

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

Pay with digicash!

Luxembourg, the

{{ "Signature of your legal representative" if form.minor_member.data else "Your signature" }}