Membership WNA (per calendar year) (80% discount)

First name *

Last name *

E-mail address *

Address *

City *

Postal code *

Comment

Country *

Phone number *

Membership *

up to and including 17 years (€ 4,50)

18 years and older (€ 5,50)

Club membership ( €15,00)

Name parent / guardian / representatie *

Phone number parent / guardian / representatie *

*

Parent / Guardian / Representative declares to agree with the above and has entered the personal details below truthfully.

Name club

Date of birth

Amount

€

Payment Method

Mollie-WNA

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

By registering, I accept Terms and Conditions

Registration