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Registration form for "Reboot and Rise"
Welcome , nice that you sing up for "Reboot and Rise".
Please fill in this form correctly and completely

The registration with this form is not yet a confirmation. If you are registered, we gone send you our bank account.  After we have received your money, you will receive the confirmation.  
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your name *
your gender, pronoms
your age *
your phone number
your e-mail address  *
your hometown
special diet 
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Do you have any allergies, diseases or handicaps , we need to know about?
How can we help you with that?

(In case it seems necessary we gone contact you for further information.)
In case of emergency, whom do you want us to contact? Please right down the name and address of this person.
Are there any Triggers we need to know about, and how can we help you to deal with them? (Do you want to be informed, if we talk about certain topics?...)
Is there something else, you want to let us know?
May we contact you, if we need more information from you?
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I pay the following price. *
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