6 uur van Aalter, registration form

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Pre-inscriptions until 15/07/2012.

If you register, you automatically accept the 6 uur van Aalter "general terms and conditions".

E-mail
First name
Last name
Date of birth
Street
Nr
Zipcode
City
Country
Language
Phone/mobile
Gender
Size
Website/blog
Money order from account nr

Wire 50€ (30€ + 20€ guarantee for the chip) to account IBAN: BE76 8900 2426 6195 BIC: VDSPBE91 and mention lastname & firstname.