Leiden Blues Registration Form
Fill out this form if you want to become a member of the Leiden Blues. By submitting this form you agree to be automatically registered with the Leiden Lions (the club facilitating this team) and give the Leiden Blues permission to send you emails.
First Name
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Initials
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Surname
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Date of Birth
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Day
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Month
Year
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Place of Birth
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Nationality
*
Address
Street Name
*
Number
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Postal Code
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City
*
Contact Details
Email
*
Phone Number
*
Hockey History
Previous Hockey Experience
*
Previous Dutch Hockey Club (if applicable)
Comments
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