JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Registration Highline Course 23
Your registration is only valid after correct payment.
Price = €400 (BeSlack member) / €420 (other KBF or CAB members)
Banktransfer to BeSlack vzw IBAN: BE89 0689 4048 8785 BIC: GKCCBEBB
Answer in NL, FR or ENG
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First name
*
Your answer
Family name
*
Your answer
City
*
Your answer
Telephone number
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
BeSlack member?
*
https://beslack.be/joinus
to become a member --> BeSlack members get a discount of - €20
Yes --> Price = €400
No --> Price = €420
KBF/CAB affiliation number (or other UIAA club)
*
Fill in the number of your UIAA club. Affliation and insurance is mandatory for acces to the rocks in Belgium! (like KBF or CAB in Belgium).
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of BeSlack.
Report Abuse
Forms
