Onligne Payment of your reservation - Stage 2

In order to prepare your activity, please seize a maximum of information in the form below. Lines marked with an asterisk are obligatory.

Informations about reservation:

Civility :

Name:

First name:

Address:

Further address details:

Postcode:

Town:

Pays :

Phone number 1:

Phone number 2:

Email:

Informations about activity:

Activity:

Date of activity:

I made contact with La Maison du canyoning, and we planned TOGETHER the activity information above.

Informations about participants:

Number of participants:

Informations about the credit card owner:

Name of the owner:

Email of the owner:

I declare that I read the relative terms and conditions of La Maison du Canyoning.