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ENROLMENT
FORM
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Name : |
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Surname: |
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Date & place of birth : |
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Adress : |
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Tel
home : |
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Mobile: |
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e-mail : |
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Indivi rapt
Insu N°. : |
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Compagnie : |
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Tel rapat ins.
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Fax Insur : |
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Pilot licence
N° : |
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Indentification
Mark ULM : |
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Type machine : |
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Registration
N° machine : |
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Date of
validity : |
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Insur N°
machine : |
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Compagny : |
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Passport N°: |
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date &
place of delivery : |
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TARIFS
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1300
€ |
Accompanying
personne : With
an option for 4 flights on two seater machine : |
1100
€
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Suppl. single : |
100 € |
Including :
Ø
Welcoming at airport and transfer to hotel
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Half-board accommodation in 3 star hotel and Berber
tents according to program
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Transport in Air-conditioned 4x4 cars during all the
Raid
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Services of a chauffeur/guide per vehicle
not included:
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Lunches during the Raid
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Drinks and other personal expenses
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Fuel for machines
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Airport taxes and frequency radio tax
Please
join a payment on account cheque of 700 Euros (to be cashed on reception) and
another cheque with balance due amount of your subscription (to be cashed at
the closing deadline for enrolments on 30 sept 2005) Cheques should be made
payable to CHOCS AVENTURES. Postal address to send files is : 6, rue de la Cavée, 78250 Gaillon sur
Montcient - France
I
declare, participate to the Raid Tunisia 2005, after having accepted its
regulations and engage myself not to proceed against the organization to claim
for penal or civil responsibility in case of accidents ( machines or persons )
or losses or theft.
Date and Signature: