Subscription Form

Subscription Form
If after the two free sessions you want to go further, the subscription fees include a whole year (training hall rent, instructors, club gear, insurance, etc.), to be wired to the club’s bank account:

Via Bruxellensis – BE44 0689 3686 6645 – 200 € – “inscription [your name]”

After the payment, please fill in this form to complete your subscription. This information is required for insurance purposes.
Date of subscription payment

DagMaandJaar
2 digit day, 2 digit month, 4 digit yearDatum
Name

First NameLast Name
Email
example@example.com
Phone number

NetnummerTelefoonnummer
Address

Straat en Huisnummer

Postbox, ...

PlaatsStaat / Provincie

PostcodeLand
Birthday

DayMonthYear
Nationality (country)
Your discord handle
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Should be Empty: