Formulaire d'inscription Rouliroula
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Nom/Name
*
Your answer
Prénom/Firstname
*
Your answer
Sexe/Sex
*
Féminin/Female
Masculin/Male
Date de naissance/Birthdate
*
MM
/
DD
/
YYYY
Lieu de naissance/Birth place
*
Your answer
Nationalité/Nationality
*
BE - Belge/Belgian
FR - Français/French
DE - Allemand/German
LU - Luxembourgeois/Luxembourger
Other:
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