Alliance Française of Birmingham
Springtime in Paris 2019 Registration Form


VERY IMPORTANT - PLEASE PRINT YOUR NAME EXACTLY AS IT APPEARS IN YOUR PASSPORT. PLEASE SEND A COPY OF THE FIRST PAGE OF YOUR PASSPORT WITH REGISTRATION FORM.
THANK YOU.

(Please complete a separate form for each person traveling)

Last:________________________ First:___________________ Date of Birth:___________________

Address:________________________________________________________________

City:________________________ State:_____________________ Zip:_____________

Phone: Home_______________ Work______________ Email:____________________

Please circle: UAB employee? YES / NO Alliance Française Member? YES / NO
(Online membership form available at: www.afbirmingham.org)

SINGLE / TWIN / DOUBLE - YOUR ROOMATE:_______________________________________________
(1 bed) (2 beds) (1 bed)

I DO NOT HAVE A ROOMATE BUT WOULD LIKE TO SHARE A ROOM:___________________________

A deposit of $399.00 should be received by November 5, 2018, to assure airline reservations. First payment of $1,000.00 by December 10, 2018, and balance of $1000.00 due before January 7, 2019. Make check payable and mail to:
Alliance Française of Birmingham
2428 Park Lane South
Birmingham, AL 35213

PARIS BY NIGHT CITY TOUR $50.00
YES / NO
(Don't send money for now, just circle if you are interested).