Book Advanced Courses - Roeicentrum Berlagebrug

Personal information

Name*

Returning customer

Ik roei al bij TopRow

Address*

Email*

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Customer number

Your customer number has 6 numbers completed with a capital P. You can find yours on the invoice we have send you last time of ask the head coach.

Teammates

i would like to add teammates

Phone*

Date of Birth*

Gender*

Team members (max 3)*

First name	Last name	Email adres

Use this part of the form to subscribe teammates. This is a real subscription, so they don't need to subscribe themselfs. If you just want to let us know you want to row with someone you can mention that in the remarks box.

Betalingsgarantie*

Ik sta garant voor de betaling van de cursusgelden van de door mij opgegeven ploeggenoten

Rowing course preferences

Course genre*

Course periode

Preferred day*

Tour Rowing is only offered in the mornings.

Preferred starting time

Voorkeurstijd

Preferred starting time

Voorkeurstijd

Flexible*

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Two hours earlier
One hour earlier
30 minutes earlier
30 minutes later
One hour later

Alternative day

Alternative starting time

Alternatieve starttijd

Remarks

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Total

0,00 €

Choice of payment*

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Card Number Expiration Date Security Code Cardholder Name

Name of account holder*

IBAN bank account number*

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Rowing course preferences

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