Registration form

Recertification Diver/Supervisor


Personal information

Surname:
Initial(s):
First name:
Adress:
Zip code:
Place of residence:
Phone number:
E-mail adress:
Date of birth:
Sex: Man Woman
Certificate code diver:
Certificate code supervisor: (If not applicable, please notify "nvt")
Citizen service number:


Billing adress

(Necesarry if different form above)
Company name:
Contact person:
Adress:
Zip code:
Place of residence:
E-mail adress:
Vat number:


Choice of recertification

You come for recertification: Diver Supervisor Diver and Supervisor

Note:
Payment = cash (no creditcard facilities).


I state that the given information is complete and truthfully filled in.
Hereby I authorize BC courses to represent me when applying for the re-certification.
I agree with the Dutch terms and conditions of BC-opleidingen.