Registration before 26th March 2004
Course-number: UBG04
Reservation-card

Please send this reservation-card to:

Dominican Activities Centre
Secretariat
Letterbox 59
NL 6850 AB HUISSEN

email: women@imd.gr

Name ……………………………………………………..Female/Male
Address…………………………………………………………………...
Zip code/City……………………………………………………………..
Telephone………………………………………………………………..
E-mail…………………………………………………………………….
Telefax…………………………………………………………………….
Year of birth………………………………………………………………
I want to make a reservation for:
Title of course:…………………………………………………………….
Course number:……………………………………………………..

I pay: ___A-Price     ___B-Price     ___C-Price

Vegetarian/diet……………………………………………………….


Date:                                     Signature


I want to make a reservation for a single-room (extra: 100,euro-) Yes/No
I want to use the possibility to make a reservation for flight tickets by Olympic Airways: Yes/No


Signature: