Contact form Meerhoven Hartveilig

You can use this form to indicate your interests in the Meerhoven Hartveilig initiative. Fields with an asterisk are required. After submitting the form, you will receive a confirmation within a few minutes at the email address you provided. Did you not receive this confirmation? Then it is probably wrongly marked as junk e-mail. In that case, check the spam folder of your mailbox.

After receiving your information, we will contact you as soon as possible. For more information, visit www.meerhoven.nl/heartsafe.

Salutation *

Mr.

Mrs.

Initials *

First name *

Prefix

Last name *

Street *

House number *

Zip code *

Place *

Phone number *

E-mail address *

Enter your e-mail address

Confirm E-mail address *

Repeat your e-mail address for verification

Are you certified?

Yes

Do not know

Are you registered at HartslagNu?

Yes

Do not know

Interests (several choices are possible)

First resuscitation course (civilian aid worker training)

Annual refresher course

Annual practice evening

Annual contact and knowledge evening

OtherwiseOtherwise

Remark