To subscribe to "The Trail of Oasis in Egypt from February 27 to 7 March 2011 Fill out this form and send a check for 450 euros booking payable to travel agency “Cap au Sud Evasion” : at the following address: Cap au Sud Evasion, 60 Avenue Emile Deschame, "Le Marianne B” 06 700 Saint Laurent du Var, FRANCE Or use as simple mode : euro bank draft to ::: CAP AU SUD EVASION IBAN : FR76 1560 7000 2525 0190 2759 665 BIC / SWIFT : CCBPFRPPNCE Paying Bank : BPCA LA GAUDE Departure Airport: London or Paris or Brussels Your details Fields marked * are mandatory: 1. Name*: 2. Name*: 3. Date of birth*: 01020304050607080910111213141516171819202122232425262728293031 JanvFévrMarsAvrMaiJuinJuilAoutSeptOctNovDéc190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999 4. Genre*: Male Female 5. Address*: 6. Telefone: 7. E-mail*: 8. You are *: Runner Companion 9. Departure airport *: ParisLondonBrussels If you are enrolled in a club 10. Name of federation : 11. Licence Number: 12. Date obtained: 01020304050607080910111213141516171819202122232425262728293031 JanvFévrMarsAvrMaiJuinJuilAoutSeptOctNovDéc 20062007200820092010 (Attach photocopy license pending) If you are part of a team 13. Team Name: 14. Number of runners: If you have a message You want insurance trip cancellation of 30 Euros, it only covers the usual conditions, if a rider may move but not run, it is not applicable in this direction. (Insurance against insurance assistance, repatriation and civil liability "are already included in the package General) 15. Your message: Other information (To T-Shirt or specific runner technical clothe) 16. Your Size (Unisex) * : XSSMLXL or if error :