tripreg

Alliance Française of Birmingham
Springtime in Paris 2012 Registration Form
VERY IMPORTANT - PLEASE PRINT YOUR NAME EXACTLY AS IT APPEARS IN YOUR PASSPORT. THANK YOU.
(Please complete a separate form for each person traveling)

Last:___________________________________ First:_____________________________

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:________

Days / Nights

Dates-March 2012

Total Cost
(Double occupancy)

Single supplement

Deposit
(no refund after 11/14/11)

Due by 11/14/11

First Payment

Due by
12/14/11

Final Payment

Due before 01/30/12

8/7

3/17 - 3/25
UAB Spring Break

$1,989.00

$500.00

$299.00

$850.00

Balance

4 OPTIONAL DAY TRIPS (Don't send money for trips now, just circle the trips you want).
NORMANDY: Bayeux Museum and Omaha Beach American Cemetery $150.00 YES / NO		CASTLES OF THE LOIRE VALLEY: $150.00 YES / NO
REIMS CATHEDRAL & CHAMPAGNE WINERY: $150.00 YES / NO		CHARTRES CATHEDRAL & VERSAILLES: $150.00 YES / NO
PARIS BY NIGHI T CITY TOUR $30.00 YES / NO	Optional Intensive French class at AF in Paris: $500.00 YES/NO

Please Mail This Form with Deposit of $299.00 (per person, non-refundable) by November 14, 2011.
(Please add $50.00 if you are not a UAB employee or an Alliance Française member)
Make Check Payable To: Alliance Française of Birmingham
Mail to: 413 Clermont Drive, Birmingham, AL 35209