| Mr. / Mrs. / Miss | |
| Address: | |
| Postal code-City-Country: | |
| Tel. no.: | |
| E-mail: |
The due payment of € 82,50 should be deposited, after 1 January 2010, into:
account number (ING Bank) 4647453
of Dans School Forom
Aarhuispad 22
3067 PR Rotterdam
The NetherlandsFor payments from abroad please mention:
ING BANK,
IBAN: NL61 INGB 0004 6474 53 and BIC: INGB NL2A
| He/she would like to rent a bed in the sleeping-hall, including breakfast at € 15.00 per night per person. | O YES | O NO |
| He/she would like to make use of the sleeping-hall+breakfast facilities at € 11.00 per night | O YES | O NO |
| He/she would like to camp at € 5,- per person per night. | O YES | O NO |
| He/she would like to camp with his/her own caravan/camper at € 6.50 per night per person. | O YES | O NO |
| He/she would like to join the BALKAN DINNER at € 15.50 on Saturday night. | O YES | O NO |
| Vegetarian | O YES | O NO |
Payment for accommodations will be made upon arrival.
| Date: | |
| Signature: |