| RESERVATIONS are necessary before the 1st of April 2008 for the gift |
| Inscriptions will finish on the april 23rd, 2008 |
| BY POST |
BEATRIX BUARD * ALLEE DU PUITS * KERGORNET * 56530 GESTEL |
| BY MAIL |
hello.buard@orange.fr |
ONE FORM PER VEHICULE |
PLEASE FILL OUT EACH ZONE |
| PILOTE |
| MALE |
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FEMALE |
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BIRTH DATE |
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| NAME |
|
1st NAME |
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MAIL |
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| ADRESS |
| STREET |
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| ZIP CODE |
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TOWN |
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COUNTRY |
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| PASSENGER |
| NAME |
|
1st NAME |
|
BIRTH DATE |
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| NAME |
|
1st NAME |
|
BIRTH DATE |
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| NAME |
|
1st NAME |
|
BIRTH DATE |
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| MOTO |
| MODEL |
|
SIDE-CAR |
|
CLUB MOTO |
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| YEAR OF YOUR MOTORCYCLE |
|
DISTANCE +/- HOME->RALLY |
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| ARRIVAL - DEPARTURE |
| ARRIVAL |
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TIME +/- |
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DEPARTURE |
|
| PAYMENT |
| ADULT |
RATE |
CHILD -14 |
RATE |
CHILD -5 |
RATE |
Total amount |
|
85,00 € |
|
43,00 € |
|
15,00 € |
|
| Transfer date |
|
Paiement on the Arrival |
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| COMMENT |
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