Inschrijfkaart Internationaal Educatief Project

Inschrijfkaart Internationaal Educatief Project

Inschrijfkaart Internationaal Educatief Project Embouchure, ademsteun & zang 2 november 2013
(registration card “The Amazing World of Embouchure, Breath support & Singing” 2 november 2013)
Voorletters (Initials) ...................................................................................................................................................................................................
Naam (Family name) ...................................................................................................................................................................................................
Adres (address) .............................................................................................................................................................................................................
Huisnummer (number) .................................... Postcode (postal code) ...................................................................
Woonplaats (city) ...........................................................................................................................................................................................................
Land (country) .................................................................................................................................................................................................................
Geb. datum (date of birth) ................................................................................... Geslacht (sex) M / V
E-mailadres: .........................................................................................................................................................................................................................
Lid van beroepsgroep (profession) .....................................................................................................................................................
Relatienummer beroepsgroep (BIG) (registration no. profession)
.........................................................................................................................................................................................................................
0
I will use the IEPE-bus for transport (cost price)
Handtekening (signature):
0
0
0
IEPE 02.1
name Bank
IBAN code
BIC/SWIFT
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U kunt zich inschrijven tot uiterlijk 15-10-2013 d.m.v. het insturen van deze kaart.
Wij vragen van iedere deelnemer een getekende kaart in verband met de eenmalige
machtiging. Het bedrag wordt aan het eind van de maand van opgave afgeschreven.
(bij meerdere opgaven mag u deze kaart copieren of downloaden via www.revalidatie-friesland.nl)
Please register by returning this card no later than 15-10 2013. We ask that each
participant signs the card in order to comply with the once only authorization.
For a single bank transfer (if more than one subscription, you can copy this card or
download from www.revalidatie-friesland.nl)”
Please fill the following items;
With the fees IEPE will be possible to organize. The fees are proportional to the proposed income.
E.g.: a doctor making music is a doctor
SVP invullen/ please mark the following:
Deelname aan IEPE:
0 Arts (doctor)
€ 200,00
0 Therapeut/manager
€ 100,00
0 Musicus (musician)
€ 35,00
0 Student (under 25 jrs)
€ 20,00
“Vroege vogelkorting” betaling (early bird discount):
Als uw betaling binnen is voor (if you pay before) 01-04-2013
- Arts/therapeut,manager - € 20,00
- Musicus/student - € 10,00
Postzegel
mag wel
hoeft niet
Revalidatie Friesland
Adres
Revalidatie Friesland
Postbus 2, Hoofdstraat 3
9244 ZN Beetsterzwaag
Telefoon 0512-389494
The Amazing World of
Embouchure Breathsupport & Singing
Antwoordnummer 2943
9200 XB Beetsterzwaag
Netherlands