Uitschrijfformulier Nrg
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SPORTS CLUB NRG - EINSTEINWEG 6 – 3208 KK - SPIJKENISSE – (0181) 616466 – [email protected]
UITSCHRIJFFORMULIER
VOORNAAM:……………………………………………………………………ACHTERNAAM………………………………………………………………………….. ADRES:……………………………………………………………………………………………………………………………………………………………………………………...………. POSTCODE:……………………………………………………………………………….………..PLAATS:……………………….……………………………………….……. TELEFOON:……………………………………………………………………………….……..………………………………………………….….……… GEBOORTEDATUM:…………………………………………………………………………………………………………………………………………………………………… EMAIL:………………………………………………………………………………………………………………………………………………………………………………………………… LOCATIE:
O GROTE ZAAL
O RPM ZAAL
DAG:…………………………………………………TIJD:…………………………………SOORT LES:………………………………………………………………………… DAG:…………………………………………………TIJD:…………………………………SOORT LES:………………………………………………………………………… Ondergetekende zegt hierbij haar/zijn lidmaadschap per………………………………..…………………………………….op. In verband met de opzegtermijn van 2 volle kalendermaanden zal de betalingsverplichting eindigen per………………………………………………………….. BETALINGSWIJZE
*GEGEVENS ZOALS VERMELD OP AUTOMATISCHE INCASSO FORMULIER: NAAM:……………………………………………………………………………………………………………………………………………………………………………..………………….. ADRES:………………………………………………………………………………………………………………………………………………………………………………………………… POSTCODE:………………………………………………………………………………….PLAATS:…………………………………………………………………………………. GIRO/BANKREKENING NR.:..........................................................................................................................................................
REDEN VAN UITSCHRIJVING: ....................................................................................................................................................................................................................... …………………………………………………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………………………………….………
PARAAF TRAINER:
DATUM
HANDTEKENING
……………………………………………….
………………………………………………………
(INDIEN VAN TOEPASSING)
…………………………………………………….
UITSCHRIJFFORMULIER
VOORNAAM:……………………………………………………………………ACHTERNAAM………………………………………………………………………….. ADRES:……………………………………………………………………………………………………………………………………………………………………………………...………. POSTCODE:……………………………………………………………………………….………..PLAATS:……………………….……………………………………….……. TELEFOON:……………………………………………………………………………….……..………………………………………………….….……… GEBOORTEDATUM:…………………………………………………………………………………………………………………………………………………………………… EMAIL:………………………………………………………………………………………………………………………………………………………………………………………………… LOCATIE:
O GROTE ZAAL
O RPM ZAAL
DAG:…………………………………………………TIJD:…………………………………SOORT LES:………………………………………………………………………… DAG:…………………………………………………TIJD:…………………………………SOORT LES:………………………………………………………………………… Ondergetekende zegt hierbij haar/zijn lidmaadschap per………………………………..…………………………………….op. In verband met de opzegtermijn van 2 volle kalendermaanden zal de betalingsverplichting eindigen per………………………………………………………….. BETALINGSWIJZE
*GEGEVENS ZOALS VERMELD OP AUTOMATISCHE INCASSO FORMULIER: NAAM:……………………………………………………………………………………………………………………………………………………………………………..………………….. ADRES:………………………………………………………………………………………………………………………………………………………………………………………………… POSTCODE:………………………………………………………………………………….PLAATS:…………………………………………………………………………………. GIRO/BANKREKENING NR.:..........................................................................................................................................................
REDEN VAN UITSCHRIJVING: ....................................................................................................................................................................................................................... …………………………………………………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………………………………….………
PARAAF TRAINER:
DATUM
HANDTEKENING
……………………………………………….
………………………………………………………
(INDIEN VAN TOEPASSING)
…………………………………………………….
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