REGISTRATION FORM

First Name Required

Last Name Required

First and Last Name of the Legal Representative (to be completed only if the participant is a minor)

Matricule (number on your Carte de Sécurité Sociale) Required

Email Required

Mobile Phone Number Required

Adress Required

Postal Code Required

City Required

Country Required

Select your instrument 1 Required

Select your instrument 2 (only if you want to register to 2 instruments and classes)

Select the classes you want to enter for instrument 1 Required

Select the classes you want to enter for instrument 2

At the Differdange School of Blues, photos or videos of the students may be taken and used to promote our activities. Untick the box below if you refuse to have your image used by the school. Required

I authorize the Differdange School of Blues to use my image on all the school's communication media, including the school's website and various social networks.

By clicking on the registration button, you confirm to have been informed that the registration fees are non-refundable (Adult fee 50€ // Student fee <27 year 30€). This fee is to be multiplied by the number of courses selected Required

I understand that the registration fees are non-refundable in any case