Pannaproductions

Application form (only the Netherlands and possibly Belgium)

Choose your course:

Sports ”De Vendelier”, Vendelierhof 1a, Goirle; Su. 07-03-2011 inclusively Su. 15-05-2011; start training: 10.00; end training: 11.30 (€ 125,=)
E-mail parent
E-mail child
First name
Insert
Surname
Adress
Zipcode
Town
Geslacht:	Mr Mrs
Birth	dd-mm-yyyy
Phone
06 Parent
Association
Shirt size
Medical info
Diet
Details
Bank or giro account
Account name
Single authorization:	Here I authorize Sportproducties at once to write his/her bank or giro account the amount of participation in Professional Football School. This amount will be approximately 14 days to be cashed for the Professional Football School.
Agreement:	I hereby write in to me by the above-ticked Professional Football School and, I agree with the general conditions. After I receive the registration confirmation email. In the week prior to the training you will receive additional information on the specified email address.