INDIVIDUAL REGISTRATION FORM FOR SAINT-TROPEZ LADIES' AMATEUR

FIRST NAME*: LAST NAME*:
COMPANY: FUNCTION:
ADRESS : CITY*:
ZIP CODE: COUNTRY:
GOLF CLUB: CITY:
INDEX: LICENCE NO:
MOBILE NUMBER*: E-MAIL*:
POLO SHIRT SIZE:            S      M      L      XL


SPECIAL REQUESTS




COST SUMMARY

LADIES' AMATEUR WITHOUT ACCOMMODATION

AMATEUR PLAYER...........................................................................................................900 €
MEMBER GASSIN GOLF COUNTRY CLUB. ..................................................................... 600 €
NON PLAYER GUEST........................................................................................................500 €
TOTAL   €


REGISTRATION WILL BE CONFIRMED ONLY AFTER RECEIVING FULL PAYMENT
IN CASE OF CANCELLATION FULL REIMBURSEMENT EXCEPT 200 € BEFORE MAY 18, 2012
NO REIMBURSEMENT AFTER MAY 18, 2012

METHOD OF PAYMENT

BANK WIRE TRANSFER
TO PSO PRODUCTION LTD / EURO ACCOUNT
ING BELGIUM (BRUSSELS)
IBAN : BE86 3101 7739 9750
SWIFT CODE: BBRU-BE-BB