Enrolmentform

Are you interested in taking judo lessons with JAA? Please fill in this registration form.
Registration is on the condition that your trial lesson was acceptable.

Boxes with an * are compulsory.

I am registering for judo classes:*

location:*

starting on:*

Personal details new member

If you are registering for parent/child judo classes, please register under the name of the child.

Surname*
Initals*
First name*
Date of birth*

MF
Street*
Huisnummer*
Additions
Postal code*
Town/city*
Telephone number*
2nd Telephone numberr (optioneel)
Email*
2e Email (optional)

Please state if any of the following apply:

Do you hold a stadspas? Stadspas holders do not have to pay the registration fee for members under 18 years of age.

Stadspas number (19-digit code under the barcode on the reverse side of you pass. a )

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