Guichet en ligne de Bastogne

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Registration Form

_ These fields are required.

After subscription, when you will be connected, you will still have the possibility to change these settings by clicking on the "preferences" link upper left.

Personal Details

User Name (Required)

Enter a user name, usually something like 'jsmith'. No spaces or special characters. Usernames and passwords are case sensitive, make sure the caps lock key is not enabled. This is the name used to log in.

Name (Required)

Surname (Required)

National register number (use following format for Belgium : xx.xx.xx-xxx.xx) (Required)

Numbers only. Example : 12345678901

Street (Required)

Number (Required)

Box

Zip code (Required)

City (Required)

E-mail (Required)

Enter an email address. This is necessary in case the password is lost. We respect your privacy, and will not give the address away to any third parties or expose it anywhere.

Telephone

GSM

Password (Required)

Minimum 5 characters.

Confirm password (Required)

Re-enter the password. Make sure the passwords are identical.

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