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 BIOCURE Thalasso

Pre-reservation card

want to reserve a stay
* Mr Mrs Miss
* Name
*First name
* Adress
* PC      
* City
* Country
* Telephone (your mobile phone if possible)
*Mail address
Date of birth   
Occupation
         
Accommodation reservation
         
Date of arrival  
Date of departure  
         
 Your cure
         
 We want to reserve
         
* Cure beginning date  
 Cure days number      
Price  EURO      
         
Accompanist’s members:
Number of person   
         
Name and first name
         
Name and first name
         
Name and first name
         
Name and first name
         
Name and first name
         
Total amount in Euro  EURO