Beyond the Moon

Contact Form

Here you can ask all your questions.

To contact us, please print the form below, fill in your details - fields with a * are required - and send it back to us either by fax at +32 15 23 36 82 or by post at the following address: BEYOND THE MOON, Zandstraat 27k, 2223 Schriek, Belgium.

You will hear from us as soon as possible! Thank you.

I have the following question(s):

Company:
First name*:
Last name*:
Title*:
Gender*:	Male Female

E-mail*:
Street + Number*:
Postal code*:
City*:
Country*:
Phone:

Language*:	Nederlands Français English Deutsch Español
How did you find out about the BEYOND THE MOON website?*
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E-mail from friend or colleague
Word of mouth
The company you work for. Specify:
Through a family who was granted a BEYOND THE MOON wish. Name:
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Your details will be added to our database but will not be given out to third parties. You have the right to view and alter your details at any time. Thank you for your support !