Dîner Dansant

DinerDansant2017

Registration

Title *

First name *

Surname*

Email address *

Street *

No *

Postal Code *

Town *

Phone *


Guest information

Number of guests (registrant included) at EUR 70 per place*:

If possible, we wish to be on the same table as

Payment:

Amount to pay*:
Number of guests x 70 €

The name in the payment information must be identical to the name of the person who made ​​the booking.
Reservations will be considered only upon receipt of payment to the bank account:

Payment details 
EURODANSE
BIL IBAN LU36 0028 1026 8240 0000
BIC BILLLULL

I will transfer the total amount to the bank account of EURODANSE by November 17, 2017*

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