Form

Participants Age (Please select all boxes. If you have not participants in any age box please select 0)*

	Till 12yrs	13-18 yrs	19-30 yrs	31-+...yrs
Number of participants

Name of the required Hotel*

	Emmantina 4*	Palmyra 4*	Other
Hotel name

Number of hotel rooms required (Please select all boxes. If you have not rooms in any room box please select 0)*

	1 bed room	2 bed room	3 bed room	4 bed room
Number of hotel rooms

What kind of room service required?? (Please select yes of not in all boxes)*

	B/B	H/B	F/B
Room service

Do you need transportation service? (yes or not)*
Brief description of your performance*
Containing elements of gymnastics, duration, etc
Date*
/ Day / Month Year
at
: Hour Minutes
Should be Empty:

Cosmogym 2012