ESSCA - UACES - Registration

U A C E S

PERSONAL INFORMATION :
Family name :	*
First name :	*
Gender :	Female : Male :
Institution name :	*
Phone number :
E-mail address :

PRICE : 174.00€ (package for 4 nights)
Night from 02 to 03/09 :	Yes No
Night from 03 to 04/09 :	Yes No
Night from 04 to 05/09 :	Yes No
Night from 05 to 06/09 :	Yes No

* Mandatory information

Please note that the residence only offers a package of four nights. Even if you stay only three nights, the price will be the same. Breakfast is included. In order to ensure smooth organisation, please tick the boxes above concerning the different dates.