Sign Up Form (Required)

First name Surname

Address:

Tel: Email:

Please circle whether Walker or Follower (by bus)

Formulas: (please circle your chosen formula and your payment

method)

N 1: 115; N 2: 75; N 3: 25; N4: 50; N 5: 25.

If you wish to become a member of The Friends of the Comte Line, please add
15

Please note that payment must be made to the Treasurer by 25th

August 2017 by one of the following methods:

1) Bank transfer to the following account:

Banque Michel INCHAUSPE, 48 boulevard Victor HUGO, 64500-ST-JEAN- de-LUZ.

IBAN (International Bank Account Number):
FR76 1795 9000 2885 0220 2690 108 BAMYFR22

2) Bankers cheque payable in France

3) For those outside the Eurozone only: pay cash on arrival to the
Treasurer

I have read, understood and agreed the conditions of the event and I will comply
with them.

SIGNATURE

DATE_______________________2017

Please return your completed Sign Up form(s) (one for each member of your
party) to:
Hubert KIRSCHHOFFER,
1bis avenue de Montbrun, 64600 Anglet, France
hubert.kirsch@wanadoo.fr