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Sign Up Form (Required) : Hubert - Kirsch@
Sign Up Form (Required) : Hubert - Kirsch@
First
name_______________________Surname____________________
Address:_______________________________________________
_____________________________________________________
Tel:________________________ Email:______________________
Formulas: (please circle your chosen formula and your payment method)
n 1: 95 ;
n 2: 50 ;
n 3: 15 ;
n4: 35 ;
n 5: 25 .
Please note that payment must be made by 25th August 2015 by one
of the following methods:
1) Bank transfer to the following account:
Banque Michel INCHAUSPE, 48 boulevard Victor HUGO, 64500-ST-JEANde-LUZ.
IBAN (International Bank Account Number) FR76 1795 9000 2885 0220
2690 108 BAMYFR22
2) Bankers cheque payable in France
3) Payment by PAYPAL (best for those outside the eurozone)
I have read, understood and agreed the conditions of the event and I will
comply with them.
SIGNATURE
DATE_______________________2015
Return your completed Sign Up form to :
Hubert KIRSCHHOFFER,
1bis avenue de Montbrun,
64600 Anglet
France
hubert.kirsch@wanadoo.fr