Aanmeldings formulier
Inschrijving Lidmaatschap SNN
Voornamen
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Achternaam
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Land
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--Kies--
Afghanistan
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American Samoa
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Anguilla
Antarctica
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Aruba
Australia
Austria
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Slovenia
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Jersey
St. Barthelemy
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Canary Islands
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E-mail
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Sportschool
*
--Kies--
***** SNN *****
Nunchaku Amstelveen
Budo Ryu sports
De Jong Sports
Dojo ’T Loo
Dojo Den Drijver
Dojo Shintaiki
Jiritsu
Judo en Nunchaku club Spaubeek
Nunchaku Beverwijk
Nunchaku Pijnacker
Nunchaku Sattler
Nunchaku-do Yoshi Apeldoorn
Sportcentrum IJsselmuiden
Sportschool Van den Berg
Sportteam 2jam
USC nunchaku
Van Gils sport
*********
Geen sportschool lid
Name club
Adres
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Postcode
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Woonplaats
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Geboortedatum
*
Open de kalender
Telefoon nummer
*
Geboorteplaats
*
Nationaliteit
*
Naam ouder / voogd / vertegenwoordiger
*
Tel nr. ouder / voogd / vertegenwoordiger
*
Verklaring ouder voogd
*
Ouder / Voogd / Vertegenwoordiger verklaart zich akkoord met het gestelde hier boven en heeft onderstaande persoonsgegevens naar waarheid ingevuld.
Lidmaadschap
*
tot en met 17 jaar (€ 22.50)
18 jaar en ouder (€ 27.50)
Touché
*
Touché digitaal (€0,00)
Touché papier (€15,00)
Betaling Informatie
Bedrag
€
Betaalwijze
Betaal link later per e-mail
Creditkaart nummer
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Vervaldatum
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