YMCA Centre – 7 bis chemin de la Justice –

Postal address: BP 112 – 30401 Villeneuve lez Avignon cedex

Tιl. : 33 (0)4 90 25 46 20 – Fax : 33 (0)4 90 25 30 64 – E-mail : ymca-avignon@wanadoo.fr 

  Registration form 

Name of Group    :........................................................................................... 

Address for contact: ..........................................................................................

Tel:  /00/.. /……./……/……                           Fax: /00/../……../…   /……. 

                 E. Mail: .......................................................

Name of the person in charge of the group:........................................................ 

 Group composition: 

      …… Ladies/ Girls                  ages between …….&…….

         ........ Men/ Boys                     ages between …… &…….. 

………..Ladies accompanying or responsible for the group 

………...Men accompanying or responsible for the group 

…………Couple (s) accompanying                                           ……. Driver(s) 

…………Other participants (please give details) 

.........................................................................

TOTAL: /…./ persons 

Arrival ……………………..                              Departure ……………………….. 

Day of the week…………….                             Day  of the week……………. 

Time ………………………..                              Time…………………………… 

1st night of occupancy: from …………..            to ………………………………. 

Last night of occupancy from…………..           to……………………………….. 

1st meal on (date)………………………….with ……………………………………..

                                              (Please specify breakfast, lunch, packed lunch or supper) 

Last meal on (date)…………………………with ………………………………….. 

We require : Full board/………/  or Half board /……/ (please tick your choice)

We will arrive by :  Coach /……./ Train /……../

We require if available rooms with 1 or 2 beds only for leaders in the YMCA Centre (a supplement is charged for single rooms) 

Please book accomodation in a nearby hotel for…. Single  or…. Twin rooms   or … Double rooms.

We require (please state your request of accomodation)…………………..for the  coach driver(s). 

We here include (date) …………         the payment of …………………………… Euro, as the  deposit for our booking (non-refundable in the event of cancellation) 

Please book for us the following excursions:

(Please indicate days an timings you wish for each activity, we can send you information on prices)

List here :………………………………………………………………………………

Comments:…………………………………………………………………………….. 

I, (print your name)………………. …. …………..leader and duly responsible for the group (state name)……… ……………………..herby certify to have read and made myself fully acquainted with the policies and procedures of the YMCA centre and I will insure my group will be instructed to follow them. This registration form is a formal booking  

     Date:                            Signature :  

                                                                            …………………………….

                                                                          (Please print your name in full)