Word lid van het PraktijkManagers Netwerk

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Geslacht: *	ManVrouw
Voorletter(s): *
Voornaam: *
Achternaam: *
Praktijk / Prive:	PraktijkPrive
Postadres en huisnummer: *
Postcode: *
Plaats: *
Type praktijk *	TandartsHuisartsFysiotherapeutDierenartsOverig
Overig, nl:
Afstudeerjaar:
Telefoon overdag: *
E-mail adres *

	Hierbij word ik lid van het PraktijkManagers Netwerk voor euro 115 per jaar.

	Ik machtig MedischOndernemen bv om jaarlijks het abonnementsgeld voor het tijdschrift van mijn rekening af te schrijven.
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