Registration DEVINUS coaching program

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Name

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Last

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Phone

Date of birth

Make a choice of payment

I pay the whole amount in 1 time
I pay the amount in installments: the installments are explained verbally and can be found on the invoice

Account number

Your IBAN number for a possible refund

Invoice in the name of ( if applicable )

For example, for companies, cost center entry, etc.

AGREE statement

I agree to the items described above and sign up for DEVINUS INNER KIND COACHING