Adresse domicile / Home Address / Thuisadres*
Code Postal / Postcode/ Postal Code*
Locatite / Plaats / Locality*
Licence / Licentie / Licence*
Fédération / Federatie / Federation Lic 1 Manif / TAKE ON PLACE; FMB ENTRAINEMENT; DSMB; DMU; RFME; SML; FFM; ACU; FMI; MUL; KNMV; ACCR; SVEMO; FMS;
Pays / Land / Country AlgeriaAmerican SamoaArgentinaAustraliaAustriaBahrainBelgiumBrazilCôte d'IvoireCroatiaDenmarkFinlandFranceGermanyGreeceItalyLebanonLesothoLuxembourgMacaoMacedonia, the former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSwedenSwitzerlandTunisiaTurkeyUnited Arab EmiratesUnited KingdomUnited StatesZimbabweTaiwanIRLANDE

Langue / Language / Taal FR; GB; NL;