SBC'05                                                                        

Inschrijfformulier:                                                                                                

Ik word lid van v.v. Baakse Boys                                       SBC'05                                           

                                                                                              p/a Holtslagweg 4a                       

                                                                                              7223 NA Baak                            

                                                                                              Internet: www.sbc05.nl                  

                                                                                              E-mail: info@sbc05.nl                    

Voornaam:             _______________________________                                                                                             

Voorletters:          _______________________________                                                                                           

Achternaam :        _______________________________                                                                                             

Adres:                  _______________________________                                                                                               

Postcode:              _______________________________                                                                                             

Plaats:                  _______________________________                                                                                             

Telefoon:              _______________________________                                                                                           

Mobiel:                 _______________________________                                                                                             

E-Mailadres:         _______________________________                                                                                             

Geboortedatum:   _______________________________                                                                                             

Man/Vrouw:          _______________________________                                                                                                                                                           

Ik ga akkoord dat de v.v. Baakse Boys 2x per jaar de contributie mag incasseren van het door mij opgegeven Bank-Girorekeningnummer.                                                                                                    

Bank/Giro:            _______________________________                                                                                             

Bank/Gironummer: _______________________________                                                                                             

Datum:                  _______________________________                                                                                             

Handtekening:                                                                                                               

Inschrijfformulier uitprinten en opsturen naar bovenstaand adres.