Registration form for the Dance and Cultural tours 2012

Please complete in block letters, and take over the dates from your passport

Mr./Mrs./Miss
Christian name(s)
Call name
Address
Postal code		Town
Country		E-mail
Tel. Home		Tel. Work
Date and place of birth
Nationality
Passport no		Valid until
Place and date of issue

Would like to reserve a place on the trip to: ( ) Tulcea-Dobrudja, 22 - 29 september 2012

( ) Flight arranged by Stichting DOINA from/to Schiphol, Amsterdam
( ) Arranging my own flight from/to airport ……………………
with flight numbers and times ………………………………………………………
( ) Arranging my own transport: by car / by train

( ) Single bedroom ( ) Double bedroom

Remarks:
Date:
Signature:

Only after the receipt of the deposit of EUR 350.- with the ING Bank, account number 4647453 of "Dance School Forom" in Rotterdam, the Netherlands, we will take your registration into account.

For payments from abroad please mention:

IBAN: NL61 INGB 0004 6474 53 and BIC: INGB NL2A