Registration form new members

I register for *:

Swimming lessonsSwimming workoutUnderwater hockeyWater poloCompetition swimmingMasters

I have the following swimming diplomas*:
NoneABCSwimming Skill

Swimming lessons

My preferred day of the week is*:
TuesdayWednesdaySaturday

I have the following swimming diplomas*:
NoneABCSwimming Skill

Underwater hockey

I'm participating with*:
with logbook numberwithout logbook number

I have*:
First aid knowledgeNo first aid knowledge

Water polo

I'm participating with*:
Swimming polo or inflowCompetition

Competition swimming

I'm participating with*:
With starting numberWithout starting number

Personal details

Family name*

Given name*

Initials*

Day of birth (dd-mm-yyyy)*

Gender*
MaleFemale

Address*

Postal code*

City*

Phone number*

E-mail address*

Remarks

Agreement

Yes, I agree that my data will be used by VZV Njord for all communication during my membership.

*Required fields

Primary Sidebar

V.Z.V. Njord
De Wal 152
5501 HP Veldhoven

V.Z.V. Njord
De Wal 152
5501 HP Veldhoven

Realisatie: Supportpunt in samenwerking met V.Z.V. Njord