Aanmeldingsformulier Contactdag 29-09-2007 Stichting Noonan Syndroom

 

 

 

Ik wil mij hierbij aanmelden voor deelname aan de contactdag:

 

Naam:                            ……………………………………………….

Adres:                            ……………………………………………….

Postcode en plaats ……………………………………………….

Telefoon:              ……………………………………………….

E-mail:                           ……………………………………………….

 

                                  

Met hoeveel personen komt u?

 

Aantal volwassenen inclusief oppas ………………………..         x € 15,- = €

Aantal kinderen tot 16 jaar……………………………………         x €   3,- = €  

 

Bent u al donateur van de Stichting Noonan Syndroom:   ja / nee 

 

Indien u met nee beantwoordt zijn de extra kosten per gezin:     x € 20,- = €      

                                                                                                  ---------------

Totaal:                          €

         

Dit bedrag heb ik overgemaakt op gironummer 9604680 t.n.v. Stichting Noonan Syndroom Enschede.

 

 

 

 

  


 

Translation

Registration form contact day 29-09-2007 foundation Noonan syndrome

I want submit an application for participation to the contact day:

Name:                        .......................................................

Address:                         .......................................................

mail code and place     .......................................................

Tel.:                    .......................................................

E-mail:                                    .......................................................

                                        

With how many persons you come?

Number of adults including watches out .............................         x € 15, - = €

Number of children up to 16 years ..........................................         x €   3, - = €  

Are you already donateur of the foundation Noonan syndrome:   yes/no 

If you answer with no the extra costs by family be:     x € 20, - = €        

                                                                                                                        ---------------

Totally:                          €

         

This amount I on gironummer 9604680 t.n.v. have transferred. Foundation Noonan syndrome Enschede.

 

 

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