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Elders Dance & Culture Registration Form

This document is a registration form for a dance and culture workshop for elders from January 10th to 22nd, 2011 in Senegal. It requests the participant's contact information, whether they will participate with a spouse, if they want to share a room, and outlines the payment terms of a 50% deposit due at registration and the remaining 50% due by November 1st, 2010. It provides the workshop fee, bank details for payment, and cancellation fees of 10% until November 31st or 50% after December 1st.

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patricia4366
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60 views2 pages

Elders Dance & Culture Registration Form

This document is a registration form for a dance and culture workshop for elders from January 10th to 22nd, 2011 in Senegal. It requests the participant's contact information, whether they will participate with a spouse, if they want to share a room, and outlines the payment terms of a 50% deposit due at registration and the remaining 50% due by November 1st, 2010. It provides the workshop fee, bank details for payment, and cancellation fees of 10% until November 31st or 50% after December 1st.

Uploaded by

patricia4366
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Registration Form

DANCE AND CULTURE FOR THE ELDERS


from 50 years

From January 10th to 22nd, 2011


Ecole des Sables | Toubab Dialaw | Sénégal

.
Confirmation of registration to be returned no later than October 15th, 2010.
Think of limited places

I confirm my registration for « dance and culture for the elders »

Name: Surname:
Date of birth: Place of birth:
Address: City:
Zip code: Country:
Tel/Fax: E-mail:

I participate with my spouse: Y yes N no


Name of the spouse:
Please fill also a form for the spouse.

I want to share my room with an appointed participant:


Name of the person:

Payment by bank transfer with the following terms of payment


At the moment of the registration, payment of 50 % of the workshop fee (600
euros),
The rest (50 % / 600 euros) has to be payed at the latest on November 1st, 2010.
The bank charges are the responsibility of the participant.

Bank details:
Account holder: Acogny / Jant-Bi
Bank : Crédit Lyonnais, Toulouse, France
Bank No. : 30002 Bank account : 12070A Key: 91 Counter :
04038
IBAN: FR73 3000 2040 3800 0001 2070 A 91
SWIFT: CRLYFRPP

For all information :


Jant-Bi / Tel. : +221 33 836 36 19 ou +221 33 836 23 88 / jantbi@[Link]

In case of cancellation, until November 31, 10 % (120 euro) of the total cost of the
training will be retained. For cancellation after December 1st, 50 % will be retained)

Read and approved


Date : Signature

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