Application Camp Yachad 2010 (1 per person)
Please click on 'verstuur' to send you application form
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Vereiste velden
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Name:
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Last name:
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Street + number:
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Postal code + city:
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Country:
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E-mail:
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Date of birth dd/mm/yyyy:
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Gender:
Female
Male
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Type of dancer:
Dancer
Student Dancer
Non Dancer
Child < 12 years
Child < 6 years
Child < 2 years
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Meal:
Non-vegetarian
Vegetarian
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Type of room:
Dormatory
Double-room (not for student-dancers)
Single-room (not for student dancers)
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I will pay my deposit by:
Bank transfer
To Miryam Koifman
I would like to share a room with:
Other remarks:
Dance Level:
Advanced
Beginner
Non-dancer
Please click on 'verstuur' to send your application form. To delete, click on 'wissen'.
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