Docstoc

RegistrationtoEUPC10inBelgium

Document Sample
RegistrationtoEUPC10inBelgium Powered By Docstoc
					Registration to EUPC 10 in Belgium
Please fill in this form for registration to EUPC 10, and send it back by email or
by postmail at Sabine Jaucot, Rue du Château 57, B-1470 Bousval, Belgium

Feel free to contact us by email : convergence@festivalpermaculture.be


First name and Surname
Address


Country
Phone/Cell
E-mail
Permaculture certificate Place, Date, Teacher(s)




Personal information (any important illness, handicap or food limitation)




Accomodation :


   o   Camping in my own tent                                  100 euros
   o   In local’s people home                                  130 euros
   o   Lodge (I contact them myself)                           100 euros (and payment for
       room at the lodge)




Payment


Cense équi’voc asbl: IBAN : BE28 7320 2277 2520; BIC : CREGBEBB


   o   I pay as soon as possible on the bank account. My inscription will be
       effective when you'll receive money
   o   I’m not able to pay on the bank account, please tell me how to do it
       otherwise


           EUPC 10 - www.festivalpermaculture.be - convergence@festivalpermaculture.be
           Sabine Jaucot – rue du Château 57, B-1470 Bousval – Belgique - +32 10 61 51 70
Amount of money registration + donation if I want to/am able to :




Way of transport so we can send you the travel information :


   o   Train
   o   Bus
   o   Plane
   o   car


Arrival town, day and time


Departure day and time




Presentation I would like to make during the convergence time and equipment
needed, language of the presentation




Languages I understand


       o     French
       o     English
       o     None of those. I'll bring my own translator




Date                                                             Signature




             EUPC 10 - www.festivalpermaculture.be - convergence@festivalpermaculture.be
             Sabine Jaucot – rue du Château 57, B-1470 Bousval – Belgique - +32 10 61 51 70

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:5
posted:10/17/2012
language:Unknown
pages:2