Registration form BJJ Rotterdam

First name *

Last name *

Gender *

M

V

Date of Birth

E-mail address *

Phone number *

Address *

Zipcode *

e.g. 1234AA

City *

Date of registration

Membership

Single lesson: €15,-

10-lessons card: €100,- (€10,00 per lesson)

Membership "1 x per week": €35,- p/m (€8,75 per lesson)

Membership "unlimited": €50,- p/m (€4,17 per lesson)

Bankaccount number (IBAN) *

Ascription *

I am 18 years or older

For registration and direct debit authorization you must be 18 years or older or have permission from a parent/guardian.

First name parent/guardian *

Last name parent/guardian *

E-mail address parent/guardian *

Phone number parent/guardian *

I hereby authorize BJJ Rotterdam to collect the monthly contribution by direct debit. *

I agree with the Terms and Conditions *

I give permission to use my e-mail address for news items about BJJ Rotterdam.

I give permission to share photos and videos I'm on externally via WhatsApp / internet. (Website, YouTube, Facebook, Instagram) *

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