ClubCollect

First Name (required)

Infix

Last Name (required)

Gender (required)

Male

Female

Rather not say

Date of Birth (required)

Contact Email (required)

Phone 1

Country Code (required)

Number

Find Address

Type in some of your address details to locate your address

Address line 1 (required)

House No. *

Extension

Address line 2

Postcode (required)

City (required)

Country

Payment Type

Pay directly

Type of Membership (Subscription/Plan) (required)

Please select Muziek op Schoot (= Toddler Music)

Jouw naam als contactpersoon / Your name as contact person (required)

Please enter your full name as contact person who will also receive the invoice

MSD Status

This status will be assigned by Muziekschool Diemen.

Additional Info

Please enter additional information such as an explanation on previous questions.

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