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Voornaam / First Name

Van / Last Name

Email:

Sel Nr / Cell Number

Kind/Dansmaat se Naam / Child/Dance Partner's Name
U Dansmaat se naam hier vir Volwasse vorm / Add your Dance Partner's name here for the Adult form

Kind/Dansmaat se Sel Nr / Child/Dance Partner's Cell No
U Dansmaat se Sel Nr hier vir Volwasse vorm / Add your Dance Partner's Cell No here for the Adult form

Ouer of Volwassene se Adres / Parents or Adult's Address

Straat Naam en No / Street Name and Nr

Stad / City

Poskode / Postal Code

Province

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Parent's / Adult's Occupation

Ouer - Volwassene se Werkplek / Parent's - Adult's Place of Work

Ouer-Volwassene se werk Adres / Parent - Adults's Work Address

Lidmaatskap Terme & Voorwaardes / Membership Terms Ek aanvaar die DansKlub Lidmaatskap Voorwaardes! / I have Read & Agree to Danceclub Conditions.