Noorderwind - Registration Form

Personal details required for registration for the Noorderwind Summer Course 2013, organised by Zwaardkunstvereniging De Orde der Noorderwind. These details will be handled with care and confidentiality and will never be shared with third parties.

Do you already have a forum account?

Yes
No

Do you wish to create a forum account?

Yes
No

Username

Password

Name

Surname

Address

Postal code

City

Telephone number

Email

Gender

Date of birth (dd-mm-yyyy)

- -

Yes, I am 17 years or older in July 2013 and I would hereby like to register for the Noorderwind Summer Course 2013.

Are you member of Noorderwind?

Yes, Militia member Yes, Crew member No

Have you participated in a Noorderwind Summer Course before?

Yes, in:
No

Which package would you like to register for?

See also the terms and conditions for more information.

A1, Standard All-Inclusive at € 225,-
A2, Standard Basic at € 210,-

C, Extra Lodging (Sunday on Monday) at € 12,50

Is there anything with food to be taken into account?

I am a vegetarian
I am allergic to (please indicate the seriousness of the allergic reaction to each product):

In order to get a proper impression of your experience with (Medieval) martial arts and / or acting, we ask you to answer the following questions as truthfully and completely as possible. The answers will be used in determining the final main program and available workshops.

Do you have any experience with Medieval martial arts?

Yes, since:
No

On a scale of one to ten, how much experience you have in it?

Do you have any experience with other martial arts?

Yes, since: with
No

On a scale of one to ten, how much experience you have in it?

Do you have any experience with acting and / or role playing?

Yes, since: with
No

On a scale of one to ten, how much experience you have in it?

At certain moments during the summer course the group will be split up in smaller sub-groups.

With whom would you like to be in one of these sub-groups?
(we will of course do our utmost to make your preferences possible, however we can not guarantee anything)

No preferences
I would like to be in the same group as:
1)
2)

In addition to the basic program we will also be offering several workshops in which it will be possible to focus on specific weapons and / or elements of the medieval martial arts and / or stage combat.

Do you have any preference(s) or idea(s) for these workshops?
(in case there is enough interest in a particular subject, we will do our utmost to make it possible to have that workshop on the summer course, however we cannot guarantee its eventual scheduling)

Multiple answers are possible, please number them in order of preference.
Sword & buckler techniques
Sword & buckler sparring
Spear techniques
Spear sparring
Dagger techniques
Dagger sparring
Unarmed combat
Staff techniques
Staff sparring
Biomechanics
Stunt techniques
Longsword sparring
Meisterhauen
One handed weapon and shield
Mêlée-games
One handed sword
Archery
Stick fighting
Pollaxe
Other, namely:
Other, namely:
Other, namely:

What is your T-shirt size?

I became aware of the existence of the Noorderwind Summer Course through:

the Noorderwind website
the Summer Course mailinglist
the Noorderwind facebook
the internet
a friend
an earlier participant
otherwise, namely:

We consider the details provided under this section, just like all other registration details, to be highly personal and confidential. We will handle these details with the utmost care and the information within shall not be shared with third parties.

In case of an accident, please contact

Telephone number

Relation to

General practitioner

Telephone number general practitioner

Blood type

I am able to perform normal physical activities

Yes
No, there are physical limitations:

I am allergic to (in particular with respect to food):

I am currently suffering (or have suffered in the past) from the following symptoms

Muscular diseases
Migraine
Dizziness
Diabetes
Depression
Emotional exhaustion
Epilepsy
PTSS
Asthma
Dyspnoea
Hyperventilation
Bronchitis
Rheumatism
Back pain
Hernia
RSI
Other, namely:

I am currently taking the following medications:

I am allergic to the following medications:

Registration form Noorderwind Summer Course 2013
Before filling out the registration form, please be sure to read the terms and conditions carefully (Dutch version can be found here)!
Personal details required for registration for the Noorderwind Summer Course 2013, organised by Zwaardkunstvereniging De Orde der Noorderwind. These details will be handled with care and confidentiality and will never be shared with third parties.
Forum account
Do you already have a forum account?	Yes No
Do you wish to create a forum account?	Yes No
Username
Password
Personal details
Name
Surname
Address
Postal code
City
Telephone number
Email
Gender
Date of birth (dd-mm-yyyy)	- -
Registration details
Cross off / select / fill in all applicable fields
Yes, I am 17 years or older in July 2013 and I would hereby like to register for the Noorderwind Summer Course 2013.
Are you member of Noorderwind?	Yes, Militia member Yes, Crew member No
Have you participated in a Noorderwind Summer Course before?	Yes, in: No
Which package would you like to register for?	See also the terms and conditions for more information. A1, Standard All-Inclusive at € 225,- A2, Standard Basic at € 210,- B1, Reduced All-Inclusive at € 205,- B2, Reduced Basic at € 190,- B3, Reduced Veteran at € 125,- C, Extra Lodging (Sunday on Monday) at € 12,50
Is there anything with food to be taken into account?	I am a vegetarian I am allergic to (please indicate the seriousness of the allergic reaction to each product):
Other details
Cross off / select / fill in all applicable fields
In order to get a proper impression of your experience with (Medieval) martial arts and / or acting, we ask you to answer the following questions as truthfully and completely as possible. The answers will be used in determining the final main program and available workshops.
Do you have any experience with Medieval martial arts?	Yes, since: No
On a scale of one to ten, how much experience you have in it?
Do you have any experience with other martial arts?	Yes, since: with No
On a scale of one to ten, how much experience you have in it?
Do you have any experience with acting and / or role playing?	Yes, since: with No
On a scale of one to ten, how much experience you have in it?
At certain moments during the summer course the group will be split up in smaller sub-groups.
With whom would you like to be in one of these sub-groups? (we will of course do our utmost to make your preferences possible, however we can not guarantee anything)	No preferences I would like to be in the same group as: 1) 2)
In addition to the basic program we will also be offering several workshops in which it will be possible to focus on specific weapons and / or elements of the medieval martial arts and / or stage combat.
Do you have any preference(s) or idea(s) for these workshops? (in case there is enough interest in a particular subject, we will do our utmost to make it possible to have that workshop on the summer course, however we cannot guarantee its eventual scheduling)	Multiple answers are possible, please number them in order of preference. Sword & buckler techniques Sword & buckler sparring Spear techniques Spear sparring Dagger techniques Dagger sparring Unarmed combat Staff techniques Staff sparring Biomechanics Stunt techniques Longsword sparring Meisterhauen One handed weapon and shield Mêlée-games One handed sword Archery Stick fighting Pollaxe Other, namely: Other, namely: Other, namely:
What is your T-shirt size?
I became aware of the existence of the Noorderwind Summer Course through:	the Noorderwind website the Summer Course mailinglist the Noorderwind facebook the internet a friend an earlier participant otherwise, namely:
Medical details
We consider the details provided under this section, just like all other registration details, to be highly personal and confidential. We will handle these details with the utmost care and the information within shall not be shared with third parties.
In case of an accident, please contact
Telephone number
Relation to
General practitioner
Telephone number general practitioner
Blood type
I am able to perform normal physical activities	Yes No, there are physical limitations:
Please leave the following fields empty if they are not applicable.
I am allergic to (in particular with respect to food):
I am currently suffering (or have suffered in the past) from the following symptoms	Muscular diseases Migraine Dizziness Diabetes Depression Emotional exhaustion Epilepsy PTSS Asthma Dyspnoea Hyperventilation Bronchitis Rheumatism Back pain Hernia RSI Other, namely:
I am currently taking the following medications:
I am allergic to the following medications:
Questions, suggestions and / or remarks