Samotnia Refuge Mountain School

ul. Na Sniezke 6
58-550 Karpacz
Poland
Phone/fax: +48 75 76 19 376
e-mail: biuro@szkolagorska.com
http://www.szkolagorska.com

 

Name of course Date




Registration form:

 

Name and surname:

 

Address and phone number:

 

e-mail:

 

Birth date:

 

Advance payment :

 

 

Advance payment, what is 30% of the total price of the event, has been paid to:
Bank Account BZWBK SA 22-1090-1926-0000-0001-0150-9268
or IBAN PL22109019260000000101509268

I confirm the authenticity of the data given above and I accept "Participation Condition"

 

 

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Legible participant's signature

 

The "Mountain School of the Samotnia Refuge" is licensed by Lower Silesian Local Government and owns a permission for touring events organization dated August 5th, 2002r. license number 34/Z/2002.