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Important Information

You will need to fill in this form to confirm your participation before the 10th of April 2012. Once you have sent it, we will contact you to validate your information and ask you for your flights details. You will need to book your flights so as to arrive in Bali Denpasar airport in the afternoon of Saturday the 28th of April 2012 before 6 PM if possible.

The Pure Gold Sales Excellence Club 2012 officially ends on the Afternoon of Wednesday the 2nd of May unless you extend your stay. (Cf Stay Longer menu). It is your responsibility to make sure you have a valid passport and necessary visa.

Please fill in the form

You will need to fill in this form to confirm your participation before the 10th of April 2012.

* Home address in order to send you your travel package.

 
Yourself  
Civility :
Your Firstname :
Your Lastname :
Date of birth :
Nationality :
Passport number :
Date of issue :
Date of expiry :
Home Address :
Zip Code :
State :
City :
Country :
Home phone number :
Mobile phone number :
Your size (European standard) :
Accompanied by  
Civility :
Your Firstname :
Your Lastname :
Date of birth :
Nationality :
Passport number :
Date of issue :
Date of expiry :
Mobile phone number :
Your size (European standard) :
Information  
Comments, special diet,
allergy for both of you...
E mail address* :
Confirm E mail address* :
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