Register First Name:*Surname*Date of Birth*Telephone number*Street*House number*Zip Code*Town*AON (Fill in the number)E-mail Address*Choose your pharmacy where you pick up your medication:*Pharmacy HanzepleinPharmacy PaddepoelPharmacy SelwerdPharmacy DiephuisPharmacy BoterdiepPharmacy De WiljesPharmacy HelpmanPharmacy OosterpoortPharmacy VenemaPharmacy BeijumPharmacy Vinkhuizen