Belgian Club of Thailand - on-line registration

Please fill out below BCT membership form and click on [Submit registration], your application will then immediately be forwarded to the Secretary for further processing

BCT Membership Application Form

BCT Membership submission

Last Name:*

First Name:*

Birthplace:*

Date of birth:*

Nationality*

Pref. language

Family

Name

Date of Birth

Place of Birth

Partner

Children

Phone (home):

Mobile (home):

Fax No. (home):

Home Addr.:

e-mail address*

Phone (office):

Mobile (office):

Fax No. (office):

Business Addr.:

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