Form Skiff Liteboat - Roeicentrum Berlagebrug

Personal information

Name*

Returning customer

I have a customer number

Address*

E-mailadres*

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.

Phone*

Date of Birth*

Gender*

Rowing course preferences

Course periode*

Liteboat cursus

Kies hier je Liteboat cursus
- Beginner, experienced in a 2 or more person rowing boat
- Gevorderd, exeprienced in a one person Liteboat

Preferred day*

It will be busy in the skiffs. We will try to match rowing times as close as possible to the preference, but we have limited spots available. So we might have to use some flexibility.

Preferred starting time*

8:30
9:30
10:30
11:30

Voorkeurstijd Zaterdag*

Peference Sunday*

Preferred starting time*

9:15
10:15
11:15

Flexible start time*

Select All
One hour earlier
One hour later

Alternative day

Remarks

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How did you hear about us?

I already row with TopRow
Friends
Facebook
Instagram
Google
Other

Choice of payment*

Name of account holder*

IBAN bank account number*

Korting voorjaar 1 zaterdag

0,00 €

Korting voorjaar 1 zondag

0,00 €

Discount Spring-1 monday

0,00 €

Korting voorjaar 2 zondag

0,00 €

Total

0,00 €

Skiffcursus Liteboat

Personal information

Rowing course preferences

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