Live, enjoy and dare..... also with vitiligo!

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Become a member for a child

Are you not yet 18? Or do you, as a parent, want to register your child as a member of Vitiligo.nl? Please complete the form below.

I am/my child is a* BoyGirl

Last name*

First name*

Street*

House number*

Postal Code*

Place*

Where do you live (Netherlands or Belgium)*

Date of birth*

Phone number*

Child's email*

Name parent*

Parent email*

Iban number

Name of account holder*

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