Registrate membership

I want to registrate as a member of TTV Diemen

Today's date

First name

Last Name

Adress

Postal code

City

DOB (dd/mm/jjjj)

Gender

Male

Female

Other

Cellphone

Email

Want to play competition?

Yes

No

Earlier member of NTTB tabletennis club?

Yes

No

Which club

Old NTTB numberWeet niet / Don't know: ?

Playd NTTB competition

Yes

No

Welke klasse

I authorize TTV DIemen to cash my membership fee with:

Direct debit each quarter

IBAN account number

Name on account

Allow pictures of me to be used in publicity for TTV Diemen

Ja

Nee

Message

Select image of : de appel / the apple