I register for La Rencontre d'Avignon



I will be present from  to

You represent



Your personal data



Civility : First name : Surname :
Position : Name of local government/organisation :
Address :
Postal code :
City :
Country :
Telephone : Mobile :
E-mail : Fax :

Accompanied by



Civility : First name : Surname :


S/he will be asked to pay a financial contribution to meals and visits: contact us.

Travel



Arrival in Avignon : Time :
Departure from Avignon : Time :

Accommodation



Please reserve a room from to

Hôtel Ibis Avignon Gare
Hôtel Kyriad Avignon Courtine
Novotel Avignon Centre
Other hotels: contact François Bosca at +33 (0)1 56 54 26 34

in room single double twin

Payment



I pay my registration fees for an amount of euro

I ask Les Rencontres to invoice my accommodation fees for an amount of euro

I will pay the total amount of euro, by bank transfer *

I will pay my shows tickets for an amount of euro, by bank transfer *


Please specify the name, title, service, address, tel. and email of person the invoice should be sent to :
* Sans frais pour le bénéficiaire. Tout frais de transfert et de commission sont à la charge du donneur d'ordre. Veuillez indiquer clairement l'objet du paiement (adhésion, frais d'inscription, etc...) à votre banque afin que notre service de comptabilité l'identifie rapidement.

Performances and visits



1 - Visits 21/07/12

Meals



1 - Welcome reception 19/07/12
2 - Lunch 20/07/12
3 - Dinner 20/07/12
4 - Lunch 21/07/12
5 - Dinner 21/07/12

Debats



I wish to speak in :

Message :

Insurancy



I certify that I have a valid and appropriate insurance policy for my travel and stay.