LJC Travel Information Sheet


LAST NAME						First Name

Nationality						Date of birth

French social security no

Passport number 					Valid until

E-mail

Phone							Fax

Position:

Affiliation:




PERSONAL ADDRESS:

CITY 							Postal Code

COUNTRY




BANK INFORMATIONS (when possible also provide a Releve d'Identite Bancaire)

Name and address of the bank

IBAN, account number

SWIFT, BIC (bank identification code)




MODE of TRAVEL 

Tickets requested:	YES/NO

Mode of travel:		PLANE/TRAIN

INBOUND Journey
From:		To:	Via:
Departure Date:		Time: 
Arrival	 Date:		Time:

RETURN Journey
From:		To:	Via:
Departure Date:		Time: 
Arrival	 Date:		Time:




ACCOMMODATION

Hotel reservation requested: YES/NO