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Les Auberges de Jeunesse - Fête de la musique 2011
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Surname*
First Name *
E-mail*
Address*
 
Telephone*
Date of birth*
*compulsory fields
I would like to
order
CADET membership cards (3-15 years)
at a cost of €4.00 per card.
 
JUNIOR membership cards (16-25 years)
at a cost of €10.00 per card.
  SENIOR membership cards (26 years and over)
at a cost of €16.00 per card.
  GROUP membership cards (1 card per group - only valid for recognized groups: youth associations, schools...)
at a cost of €22.00 per card.
If you are ordering more than one card, please provide the last names, first names, birthdates and addresses of the additional people in the free-form field below:

I will pay this total amount in to account number 001-0118351-87,
holder Auberges de Jeunesse asbl, 28 rue de la Sablonnière, 1000 Brussels, today.
I will receive the card(s) I ordered by post within 10 days following receipt of my payment
by Les Auberges de Jeunesse.




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