Voorinschrijving Hanze 696 (preregistration)

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Email *

Familienaam (family name)
*

Voornaam (given name)
*

Geboortedatum (date of birth)

YYYY

E-mailadres (e-mail address)
*

Adres - straatnaam (street name)
*

Adres - huisnummer (house number)
*

Adres - postcode (postal code)
*

Adres - plaatsnaam (place name)
*

Adres- land (country)
*

Voorgenomen afstand (intended distance)

Dit kun je later nog aanpassen. (You can adjust this later.)

ACP
*

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