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:

Modified on: 18 July 2010

AMSTERDAM (14x) from 08 September till 15 December 2010....... € 175,-

First name:

Surname:

Date of birth:

Street & home nr:

Postcode:

City:

Gsm /phone:

E-mail address:

Payment:

I would like to pay by 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 the above mentioned fee before beginning of the workshop.