Registration Paddle Course 2017 – Surfing Club - Surfing St
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Registration Paddle Course 2017 – Surfing Club Saint Gilles Fill this form and join : A deposit of 30% of the total amount for the reservation (for check, order : Surfing Saint Gilles). Last name : ………………………………………. Name : ………………………………………. Date of birth : ……………………… Licence : ……………..…………………… Last name : ………………………………………. Name : ………………………………………. Date of birth : ……………………… Licence : ……………..…………………… Last name : ………………………………………. Name : ………………………………………. Date of birth : ……………………… Licence : ……………..…………………… Home address : …………………………………………………………………………………………………………………………………………………………………………...................... Zip code : .................................................. Town : ...........................................................…………………………………..………………………… Cellphone number : …….. / …….. / …….. / …….. / …….. E-mail address : .................................................................................................. Person to prevent in case of accident : Last name : ………………………………………. Name : ………………………………………. Holiday address : ………………………………………………………………………………………………………………………………………………………………………………………… Cellphone number : …….. / …….. / …….. / …….. / …….. Medical information regarding the trainee (allergy, …) : ………………………………………………………………………………………………………….…………………. The formula of your choice : Trainee 1 : ……… session Rate : …….. € Date of your course : from ……… / …….. to …….. / ………. Trainee 2 : ……… session Rate : …….. € Course time : ………………………………………… Trainee 3 : ……… session Rate : …….. € • Particular lesson : ……… session Rate : …….. € For a course of one week, the Surfing offers you board rental of 2h00. Framework reserved to Surfing Saint Gilles Montant dû : Acompte : Solde : ………………………….. € ………………………….. € Chèque – espèce – ANCV – CB ………………………….. € Chèque – espèce – ANCV – CB N° chèque(s) : ………………………………………………….. / ………………………………………………….. Surfing Club Saint Gilles Phone : +33 02.28.10.63.78 - E-mail : [email protected] - www.surfing-stgilles.com Surfingclubstgilles Surfing Club Saint Gilles
