Bailarin tango

Registration form

Tango en el Desierto

Please fill in the form below and send it in to the address on the bottom of the form.

Passenger 1
Title	Mr Mrs Miss Ms
Family Name
First Name	(name must be the same as in the passport)
Address
Address line 2
Town
County
Postcode
Telephone	-
e-mail
Nationality
Passport No.
Issue Date
Expiry Date

Passenger 2

Title	Mr Mrs Miss Ms
Family Name
First Name	Name must be the same as in the passport
Address
Address line 2
Town
County
Postcode
Telephone	-
e-mail
Nationality
Passport No.
Issue Date
Expiry Date


Submit
Payment: Please make cheques payable to Alfredo Sepulveda Address:: Alfredo Sepulveda 38 White Horse Road Windsor, Berkshire, UK SL4 4PQ