Registration form - Millefeuille Provence

Name

First

Last

Date and place of birth

Profession/Enterprise/Ministry

Adress: street, city, post code

Cell phone

Course programs

Accommodation

Comments on accommodation/meals

Dates of your stay at Millefeuille Provence (From Sunday to Friday)

Total amount

20 % deposit

Payment by credit card: Visa, Eurocard/Mastercard/Amex

Bank transfer payement

BANK BNP PARIBAS, 4 place Jean Jaurès, F-30200 Bagnols-sur-Cèze// IBAN FR76 3000 4004 8300 0100 4693 783// SWIFT BNPAFRPPNIM

with (From Eurocard/Mastercard/Amex

Please send us the language test along with the registration form