English sign up sheet for the Phocas Introduction Initials First name Infix Last name Gender ManWoman Date of Birth (DD-MM-JJJJ) E-mail Phone number Steet and house number Zip code and city Study Student number Institution Radboud UniversiteitHANOther Do you have any allergies? Please let us know: ICsecretaris@nsrvphocas.nl Sports history Which sports did you practice? RowingAthleticsCyclingIce skatingSoccerTennisVolleyballSwimmingBasketballHockeySomething else Something else: How many years have you practiced this sport? How often did you practice per week? Less than two times a week2 times a week3 times a week4 times a week5 times a weekMore than 5 times a week What is your best sports performance? And in what year was that? Have you practiced rowing before? And if so, at which club? How many times a week would you like to row? 1 - 2 times a week2 - 3 times a week3 - 4 times a week4 or more times a week Do you have any interest in becoming a coxswain? YesNoI don't know Length (in cm) Weight (in kg) Authorization I hereby authorize the Penningmeester of N.S.R.V. Phocas to withdraw the amount of €32,50 from my bank account to pay for the Phocas introduction month. It is possible to decline this authorization by sending an e-mail to ICsecretaris@nsrvphocas.nl no later than the 30th of August. IBAN Name Date (DD-MM-JJJJ)
