From 13 till 15 September 2019 Team Traumaplatform will head up to F-16s use Leeuwarden Air Base for our 4th symposium and to Ameland for our challenge Triathlon for Trauma.

If you want to join Team Traumaplatform and participate in this event, fill out the form below. An extra form will open after registration
for the challenge. Your information will be used confidentially.

Name *
Name
According to your passport
Date of birth *
Date of birth
Expiration date passport *
Expiration date passport
I agree with a direct debit for every Traumaplatform event that I participate in *
Ik ga akkoord met automatische incasso voor elk Traumaplatform event waar ik aan deelneem
Physician registration number
Degree *
I want to register for (https://xterra-netherlands.nl)
In centimeters
In kilograms
I need a mountainbike
measured at height of nipples in centimeters
measured at belt height in centimeters
measured from floor to groin in cm
What is you normal clothing size
If so, please indicate which ones
Just in case! Please provide name and telephone number including countrycode
if none, please indicate 'none'
After registration you will be forwarded to the site of the XterraNetherlands. Please fill out the formular for Xterra and we will take care of your payment.