Swimming in Veldhoven

V.Z.V. Njord

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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