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Registrationform A-Tri part 5 (only for people not living in The Netherlands)
Date: 2017, May 12-14
Location: Vondelchurch Vondelstraat 120 Amsterdam
First name
Your answer
Surname
Your answer
Country
Your answer
E-mail
Your answer
I will pay (see below; tarifs only for people not living in The Netherlands)
Remarks (info: seminar@ligmincha.nl)
Your answer
Tarifs
€ 100,- (standard)
€ 50,- (students with studentpass)
Payment details
Payments are to be made before 2017 May 1st to account number of Ligmincha Nederland, Emmen.
Please include <name(s) of participant(s)> and <A Tri 2017>

IBAN NL56 INGB 0006 2885 89
BIC INGBNL2A

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