REGISTER / AANMELDEN | www.telefooncirkel-telephonecircle.com

Register

Complete the registration form to participate.

Your information will be used solely for the operation of the phone circle. It will not be shared with third parties, except in emergencies and only with a designated contact person. You can always request change, or delete your information.

Registration form

First name and last name *

Date of birth *

Gender *

Man
Woman
Other

Living conditions *

I live alone
I live with my partner

Full adress *

Emailaddress *

Phone number with country code + *

Do you have whatsapp *

Yes
No

Emergency Contact Name (optional)

Phone number with country code +

Relationship to you

Medical considerations (optional) e.g. diabetes, epilepsy

I agree to the storage of my data for the purpose of Telephone Circle *

Yes

I understand that my medical information (if provided) will only be used in case of emergency

Yes

Payment (1st month free) *

Every 6 months
Every year

Payment method *

Bizum (only for Spanish bank account with Bizum)
PayPal
Bank Transfer

PayPal account (if applicable)

Additional information/comments

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Registration form

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