I Registration Bulletin (1 per person)

    To be sent accompanied by a cheque to the value of 50% the price of the trip (+optional insurance) to the following address :
Samuel Pontoni, "le bourg" 47340 Saint Robert, France.

Name :                                   Surname :                                        Age :

Address :

Telephone/fax :                                     E-mail :

Chosen Trip :                   

Date :                                                    Price :

Cancellation Insurance, 2,85% of trip cost (optional ) :  YES  -  NO

Contact of your Civil Insurance :
(Name, Address, Tel. no.)

Police Tel no. :

If you have any extra comments, a special diet, a medical treatment or condition etc, please write to explain over-leaf of this bulletin.

   50% of the total trip price                            =
+ cost of cancellation insurance(non obligatory)  =                              
   Sum of the cheque to be sent                          =

    I have read and accept the general conditions of this contract.

             Date :                                    Signature :