September 29, 2022

Registration 2021

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Registration Date: / / 2022


I hereby register for


Course / activity / trip:


Course or class day, place and time:


First and last name:


Man Woman

Adres:


Postal Code:

residence:


Telephone at home:


Mobile phone:

Email:

Date of birth: time of birth:
I want to receive the digital newsletter: Y / N


I have / have not followed a previous course. Which?

When registering, you sign for participation and agree to 
the registration and payment conditions (see below).
Name:
signature:
Sign this form and send it to Ed Dirker


mail to createyourownworld@icloud.com