Vélocypède Association Hygiéniste

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www.jeunecyclo.fr

Phone number : 07.82.66.47.11

 


Registration form to be sent to the mailing address below. 

 

NAME_______________________________________________________________________ Male / Female 

Date of birth________________________

Address______________________________________________________________________________________________________ 

Telephone______________________Mobile____________________________________ 

Email address (Upper case please) _________________________________________________________________________________________________________________________ 

Room preference* ___________________________________________. 

Registering for the course from____________until____________20 

 

Enclosed is a cheque payable to "Association Vélocypède", with the balance due at the beginning of the course. 

I have followed a mono-diet, detox-cure: YES / NO 

I have fasted before: YES / NO If yes how many days: 

I have already participated in a course of fasting and hiking: YES / NO 

*If you choose a double room and that no one else choosen, you will occupy a single room at the most economical rate. Ask for clarification if necessary. 

I am aware of the course of fasting and hiking I am about to undertake: 

I certify that during the course I will consume no alcohol, tobacco or drugs. 

I declare to be able to walk several hours of per day. 

In order to accompany you in the best conditions, to ensure your comfort and safety, thank you for answering any questions that are asked. This information will, of course, be confidential. 

Date and signature (mandatory): 

 

_______________________________________   

Accommodation & course Shared bedroom Private  room Private room with bathroom
7 days €560 €600 €700
Deposit €100 €100 €100

 

Send the reservation with your deposit to:

Association Vélocypède 

8 Impasse des Roitelets

56270 Ploemeur

FRANCE

The balances of the course will be paid the day of arrival. 

 

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