PAX AURORA — Model withdrawal formComplete and send this form only if you wish to withdraw.To: Nadia Struiwigh / PAX AURORA, Enteldijk 3C, 7244 NL Barchem, The Netherlands, hi@paxaurora.nlI/We (*) hereby give notice that I/we (*) withdraw from my/our (*) contract for the provision of the following service: PAX AURORA Pax Pass subscription.Ordered on: ____________________Name of consumer(s): ____________________Address of consumer(s): ____________________Signature (only on paper): ____________________Date: ____________________(*) Delete as appropriate.