I register for la Rencontre des Côtes d'Armor



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 :


He/she will be asked to pay a financial contribution to meals and cultural activities

Travel



Arrival in Saint-Brieuc : Time :
Departure from Saint-Brieuc : Time :

Accommodation



Please reserve a room from to

Best Western Hôtel Le Duguesclin
Hôtel du Champ de Mars

in room single double twin

Payment



I pay for my registration fees for the conference for the amount of euro

I ask les rencontres to invoice my hotel expenses for euro

I will pay for my hotel expenses myself at the hotel reception euro

I ask les rencontres to invoice the total amount of euro, that I will pay by bank transfer*


Please specify the name, title, service, address, tel. and email of person the invoice should be sent to :
*Without bank charges for the payee. All transfer charges and commission costs are to be borne by the payer. Please make sure you clearly indicate the reason of your payment (membership fees, registration fees, etc.) so that our accountant can identify it.

Performances and visits



1 - Cultural visits, Saturday 18/09/2010 (afternoon)

Meals



1 - Welcome reception, Thursday 16/09/2010
2 - Lunch, Friday 17/09/2010
3 - Dinner, Friday 17/09/2010
4 - Lunch, Saturday 18/09/2010
5 - Dinner, Saturday 18/09/2010

Debats



I wish to speak in :

Message :

Insurancy



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