Registration Form

Please contact me to finalize any registration
Phone: 0652139610
Email: remidavid856@gmail.com
Location: Plage de la Lette Blanche

Form to be returned along with a non-refundable deposit
corresponding to the first class (€40 by bank transfer or check) to reserve your training.

Please enable JavaScript in your browser to complete this form.

Holiday Chosen week

Name *

First

Last

Email *

Phone Number

Nationality[Select Nationality]United StatesUnited KingdomChinaCanadaUnited Arab EmiratesAustraliaAndorraAfghanistanAntigua and BarbudaAnguillaAlbaniaArmeniaAngolaAntarcticaArgentinaAmerican SamoaAustriaArubaAzerbaijanBosnia and HerzegovinaBarbadosBangladeshBelgiumBurkina FasoBulgariaBahrainBurundiBeninSaint BarthelemyBermudaBruneiBoliviaBrazilBahamas, TheBhutanBouvet IslandBotswanaBelarusBelizeCocos (Keeling) IslandsCongo, Democratic Republic of theCentral African RepublicCongo, Republic of theSwitzerlandCote d'IvoireCook IslandsChileCameroonColombiaCosta RicaCubaCape VerdeCuracaoChristmas IslandCyprusCzech RepublicGermanyDjiboutiDenmarkDominicaDominican RepublicAlgeriaEcuadorEstoniaEgyptWestern SaharaEritreaSpainEthiopiaFinlandFijiFalkland Islands (Islas Malvinas)Micronesia, Federated States ofFaroe IslandsFranceFrance, MetropolitanGabonGrenadaGeorgiaFrench GuianaGuernseyGhanaGibraltarGreenlandGambia, TheGuineaGuadeloupeEquatorial GuineaGreeceSouth Georgia and the IslandsGuatemalaGuamGuinea-BissauGuyanaHong Kong (SAR China)Heard Island and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIrelandIsraelIsle of ManIndiaBritish Indian Ocean TerritoryIraqIranIcelandItalyJerseyJamaicaJordanJapanKenyaKyrgyzstanCambodiaKiribatiComorosSaint Kitts and NevisKorea, SouthKuwaitCayman IslandsKazakhstanLaosLebanonSaint LuciaLiechtensteinSri LankaLiberiaLesothoLithuaniaLuxembourgLatviaLibyaMoroccoMonacoMoldovaMontenegroSaint MartinMadagascarMarshall IslandsMacedoniaMaliBurmaMongoliaMacau (SAR China)Northern Mariana IslandsMartiniqueMauritaniaMontserratMaltaMauritiusMaldivesMalawiMexicoMalaysiaMozambiqueNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNetherlandsNorwayNepalNauruNiueNew ZealandOmanPanamaPeruFrench PolynesiaPapua New GuineaPhilippinesPakistanPolandSaint Pierre and MiquelonPitcairn IslandsPuerto RicoGaza StripWest BankPortugalPalauParaguayQatarReunionRomaniaSerbiaRussiaRwandaSaudi ArabiaSolomon IslandsSeychellesSudanSwedenSingaporeSaint Helena, Ascension, and Tristan da CunhaSloveniaSvalbardSlovakiaSierra LeoneSan MarinoSenegalSomaliaSurinameSouth SudanSao Tome and PrincipeEl SalvadorSint MaartenSyriaSwazilandTurks and Caicos IslandsChadFrench Southern and Antarctic LandsTogoThailandTajikistanTokelauTimor-LesteTurkmenistanTunisiaTongaTurkeyTrinidad and TobagoTuvaluTaiwan, Province of ChinaTanzaniaUkraineUgandaUnited States Minor Outlying IslandsUruguayUzbekistanHoly See (Vatican City)Saint Vincent and the GrenadinesVenezuelaBritish Virgin IslandsVirgin IslandsVietnamVanuatuWallis and FutunaSamoaKosovoYemenMayotteSouth AfricaZambiaZimbabwe

Age *

Height (cm) *

Weight (kg) *

Holiday Location *

Date of your chosen training week

Chosen program *

• Beginner [ From 7 years old, duration 1h:30m , beginner level, introduction to the activity ]
  
  
• Intermediate [ From 12 years old, duration 1h30, level: intermediate to advanced.
  
  
• Advanced [ From 12 years old, duration 1h30, level: intermediate to advanced.
  
  Lesson Prices:
  1 × 1h:30m = €40
  3 × 1h:30m = €110
  5 × 1h:30m = €170
  
  

Number of lessons chosen per person *

• 1
• 3
• 5

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