Registration form workshop Julien Breton (202201-ST-WE-JB) Julien Breton. 29-30/01/2022, Namur (Wépion). Nom/Name Prénom/First name Nom/Last name E-mail* Adresse/Address* Rue/Street Ville/City Code postal/ZIP Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Téléphone/TelephoneStage/Workshop* Price: Logement vendredi/Overnight stay Friday* Nuit du vendredi/Friday night (15€) Ne loge pas le vendredi/No overnight stay on Friday Logement samedi/Overnight stay Saturday* Nuit du samedi/Friday night (15€) Ne loge pas le samedi/No overnight stay on Saturday Repas/Meal* Samedi midi/Lunch on Saturday (5€) Pas de repas le samedi midi/No lunch on Saturday Repas/Meals* Samedi soir/Saturday evening (4€) Pas de repas le samedi soir/No meal on Saturday evening Repas/Meal* Dimanche midi/Lunch on Sunday (5€) Pas de repas le dimanche midi/No lunch on Sunday Devenir membre/Membership* Je deviens membre/I want to become a member (20€) Je suis en ordre de cotisation/I am already a member *Mandatory annual feeTotal 0,00 € Informations spécifiques me concernant/SpecificsAllergies alimentaires, régime, PMR, etc / Allergies alimentaires, régime, PMR, etc. / Food allergies, diet, wheelchair, etc.Confirmation* Je confirme avoir pris connaissance du règlement d'ordre intérieur et en approuver le contenu. En outre, j'accepte que mes données soient stockées et utilisées par Plumes et Calames dans l'unique but de me communiquer des informations concernant mon inscription et les activités de l'asbl Plumes et Calames. I confirm that I have read and agree with the house rules. I also agree that my personal data will be stored and used by Plumes et Calames only to send me information about my registration and about the activities of Plumes et Calames. Consultez notre Règlement d'Ordre Intérieur Pour que votre inscription soit effective, un acompte de 50€ vous sera demandé. Le solde devra être versé au plus tard 3 semaines avant le début du stage.CAPTCHA Δ Share:Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Pinterest (Opens in new window)Click to print (Opens in new window)
