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WINES & SPIRITS PROGRAM 2006 - Le Cordon Bleu

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<strong>WINES</strong> & <strong>SPIRITS</strong> <strong>PROGRAM</strong>REGISTRATION FORM <strong>2006</strong>Please complete and return this form to LE CORDON BLEU Paris and the required payment.Miss. Ms. Mr. Last Name:____________________________________First Name:___________________________________Profession: ______________________________________Permanent address:________________________________________________________________________________________________________________________________________________________________Phone:__________________________ Fax : ______________________ e-mail :___________________________Address in France:_________________________________________________________________________________________________________________________________________________________________________Phone: _________________________ Fax ________________________ e-mail: ___________________________Date of birth:_____________________Nationality:____________________Passport No. __________________HOW DID YOU HEAR ABOUT LE CORDON BLEU?Friend: Name:_________________________________________Former students Name:_________________________________________Other: please specify:__________________________________________COURSES CHOSEN:Basic: Date:_____________________________________Intermediate: Date:____________________________________Superior: Date:____________________________________PRICEPer level: 340 Euros / For the 3 levels: 870 EurosCancel fees: 38,12 Euros. No refunds will be made for cancellations after the first class dayPAYMENTREGISTRATION : FULL PAYMENT REQUIRED UPON REGISTRATION.Personal check:_______ Money order ________ Bank transfer* _________Credit Card ________: Visa _________ Mastercard ________ JCB _________Card No: _________________________________ Signature: ____________________________Expiration date: ____________________Name on card: ___________________________Amount to be charged: _____________________*BANKING INFORMATION : Bank transfer in EUROS to the “ECOLE LE CORDON BLEU”Bank: BANQUE NATIONALE DE PARIS - BNPAddress: Paris V Brancion, 26 rue de Vouillé 75015 Paris Bank code: 30 004Branch code: 01402 Account N°: 00020507765 I.D code: 95SWIFT: BNPA FRPP PXV IBAN code: FR 76 3000 4014 0200 0205 0776 595

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