Application form Taikiken in NL

Application
form

Thank you for your interest in our Taikiken training sessions in the Netherlands.
To register, please fill in following form.

Here by, I register myself as participant to Taikiken training in:

Last update: 03 February 2012

AMSTERDAM (8x) from 08 February 2012 - 04 April 2012..... € 100,-

First name:

Surname:

Date of birth:

Street & home nr:

Postcode:

City:

Gsm / phone:

E-mail address:

Payment:

I will pay via bank transfer

Please, send me the bank account information.

I will pay CASH before first session.

Skills in martial arts or sports :

What?Level?

Notes:

By this registration I engage myself to pay € 100,- before beginning of the workshop.