<p> BOOKING FORM / ANMELDEFORMULAR / FORMULAIRE D’INSCRIPTION 22. HALCAMP – RALLY v.13.04.2017</p><p>20.08 – 4.09.2017 PISZ; Hotel « ROŚ », Turystów (Av./Al.) 3, PISZ</p><p>Organizer / Organisator / Organizateur: HALCAMP Maciej Głowiński, 55-080 Kąty Wrocławskie, Spółdzielcza Str. 9-11</p><p>(mob). +48 601 48 64 45, e-mail: [email protected] ( www.halcamp-rally.pl )</p><p>PARTICIPANTS ◦ TEILNEHMER ◦ PARTICIPANTES:</p><p>Name / Surname / Nom de First name / Vorname / Date of birth/ Geburtsdatum / Date de famille Prenom naissance</p><p>1</p><p>2</p><p>3</p><p>4</p><p>Kontakt / contact (e-mail)………………………………………………………………… tel./ mobil ……………………………………………… Adres / Adresse ………………………………………………………………………………………………… Klub / Club………………………………… Motorhome / Wohnmobil / Camping-car ……………………………… Nr ……………………………… L. ………………………………</p><p>Caravan / Wohnvagen / Caravane ………………………………………… Nr ……………………………… L. ………………………………</p><p>Arrival / Anreise / Arrivée ………………………………………………… Departure / Abreise …………………………………………</p><p>Additional / Zusätzlich / Additionnel information (Diet/Diät/diete, dog/Hund/chien, cat/Katze/chat etc.) ………………………………………………………………………………………………………………………………………………………………………………………</p><p>1. Charges of residence / Campinggebühr / Paiement de s é jour </p><p>Unit 2 pers. / 1 night - 20 € ◦ Einheit 2 pers. / 1 nacht - 20 € ◦ equipe 2 pers. / 1 nuit -20 € Unit 1 pers. / 1 night - 15 € ◦ Einheit 1 pers. / 1 nacht - 15 € ◦ equipe 1 pers. / 1 nuit -15 € Extra pers. / 1 night -5 € ◦ Zusätzliche pers. / 1 nacht - 5 € ◦ pers. Supplementaire / 1 nuit - 5 € </p><p>Unit /einheit / Price / Preis / Prix Total / Zusammen / Nights / Nacht / Nuits equipe € Sous €</p><p> x x = €</p><p> x x = €</p><p>2. Supper/ Abendessen / Diner </p><p>Persons / Personen / Days / Tage / Total / Zusammen / Nombre de Pers. N Nombre de pers. Jours Sous</p><p>23.08, 28.08, 3.09 gratis</p><p>21.08,22.08,23.08,26.08 27.08,28.08,29.08,31.08, x x 8,0 € = ...... € 2.09, 3.09 3. Excursions / Touristenreise / Excursions </p><p>Persons / Persone / Price / Preis / Prix Total / Nombre de pers. € Zusammen/Sous €</p><p>Nr 1 PISZ exc. by ship “Smętek” on Roś Lake and Pisa River, coffee x 17 € = € and cake in “Hotel -Restaurant n. Pisa” walking with guide into the Pisz Town + Museum</p><p>Nr 2 KRUTYNIA, MIKOŁAJKI exc. by bus - rafting by Krutynia River, , shopping regional food and x 38 € = € souvenirs, lunch in “Krutynianka” Restaurant, visiting with guide into Mikołajki Town, Church in Okartowo </p><p>Nr 3 ŚWIĘTA LIPKA, KĘTRZYN, GIERŁOŻ, GIŻYCKO exc. by bus, visiting Sanctum in Święta Lipka + short organ concert, visiting Castle and x 40 € = € Basilica in Kętrzyn, lunch in “Stara Kamienica” Restaurant, visiting Miniatur Park in Gierłoż, visiting the Town + Hotel / Castle St Bruno in Giżycko </p><p>Nr 4 MIKOŁAJKI, GALINDIA exc. by bus to Ruciane, on ship by x 45 € = € Masurien Lakes to Mikołajki, lunch, visiting Galindia terrain/skansen</p><p>Nr 5 OLSZTYN by bus, x 35 € = € visiting with guide Town, lunch</p><p>TOTAL / ZUSAMMEN / SOUS 1 - 3 : ...... € </p><p>Before/ Vor/ Avant 10.07.2017 Account number: PL 66 1090 1522 0000 0001 1462 8039, Kod SWIFT: WBK PP L PP </p><p>In case Your resignation: 28 days before the rally – refund 90%, 14 days – 50%, 7 days – 0% Im Falle des Verzichts – Rückerstattung : 28 Tage vor dem Treffen – 90%, 14 Tage vor dem Treffen – 50%, 7 Tage vor dem Treffen – keine Rückerstattung. En cas d'annulation: remboursement 28 jours avant le rallye – 90%, 14 jours avant – 50%, moins de 7 jours – aucun rembousement. </p><p>Signature …………………………………………………… </p>