Registration form

Recertification Diver/Supervisor

Personal information

First name:
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:
Zip code:
Place of residence:
E-mail adress:
Vat number:

Choice of recertification

You come for recertification: Diver Supervisor Diver and Supervisor

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.