AZORES _ REGISTRATION

ONLY FOR BANK TRANSFER PAYMENT
Credit Card Payment go directly to other llink

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Your Phone Number

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Gender (Mandatory)
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Your Address

I know the name of my roommate :

AGREEMENT TO TERMS & CONDITIONS
Yes, I have read and accept the terms and conditionsNo, I do not accept the terms in the terms and conditions(Mandatory)

Signature: Your typed name will act as your signature:
(Mandatory)

Send your payment to :
Sylvie Duran
Triodos Bank (Spain): BIC : TRIOESMMXXX
IBAN : ES53 1491 0001 2330 0007 8297
or
Bankinter (Portugal): BIC : BKBKPTPL
IBAN : PT50026901150020104089035
Payment must be done when you send us the form.