Registration Membership

Preferred name

Official given names

Surname prefix

Surname

Place of birth (also country when outside of the Netherlands)

Date of birth (YYYY-MM-DD)

Sex
MaleFemaleOther

Address

Postal code

City

Telephone number

Email address

Number U-pas or students card

Expiration date U-pas of students card (YYYY-MM-DD)

Registration date (first training after trial month YYYY-MM-DD)

By submitting this form, the above person applies for membership of Sanshinkai Aikido Utrecht and after being admitted accepts the rights and obligations as formulated by statuary law and rules and regulations. This person also states to be physically and mentally healthy enough to practice aikido and to abide the house rules.

Name guardian, when under age of 18

Telephone number guardian, when under age of 18

Email address guardian, when under age of 18

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