Registration Paddle Course 2017 – Surfing Club - Surfing St

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.
Surfing Club Saint Gilles
Phone : [phone] - E-mail : [e-mail] - www.surfing-stgilles.com
Surfingclubstgilles Surfing Club Saint Gilles
Framework reserved to Surfing Saint Gilles
Montant dû : ………………………….. €
Acompte : ………………………….. € Chèque – espèce – ANCV – CB
Solde : ………………………….. € Chèque – espèce – ANCV – CB
N° chèque(s) : ………………………………………………….. / …………………………………………………..
Registration Paddle Course 2017 – Surfing Club
Saint Gilles