I register for La rencontre du Lazio, Rome



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 :


Fees will be required for meals and cultural programme.

Travel



Arrival in Rome : Time :
Departure from Rome : Time :

Accommodation



Please reserve a room from to

Hotel Albani
Hotel Pace Helvetia
Hotel Accademia
Hotel Tritone

in room single double twin

Payment



I pay for my registration fees for the amount of euro

I ask les rencontres to invoice my hotel expenses and I will reimburse the amount of euro

I pay for the whole amount of euro, 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 what you are making the payment for (membership fees, registration fees...) so that our accountant can identify it.

Performances and visits



1 - Movie premiere, Friday 21st November
2 - Cultural visits, Saturday 22nd November
3 - Festival Romaeuropa, Saturday 22nd November

Meals



1 - Dinner, Thursday 20th November
2 - Lunch, Friday 21st November
3 - Dinner, Friday 21st November
4 - Lunch, Saturday 22nd November
5 - Dinner, Saturday 22nd November

Debats



I wish to speak in :

Message :

Insurancy



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