Nom, prénom/ Cognom, Nom / Surname and first name |
Courriel/ correu electronic/ email |
| ..................................................................................... | .......................................@.......................................... |
Adresse/ Adreça / Adress |
Date et signature/ data i firma/ Date and signature |
..................................................................................... |
................................................................................. |
..................................................................................... |
|
..................................................................................... |
Les billets ne sont ni repris ni échangés |
Téléphone/ Telèfon/ Phone number |
no es recuperen ni es canvien els billets |
| ....................................................................................... | Tickets are neither taken back nor refunded |
| CONCERT | A |
B | UNIQUE |
REDUIT |
TOTAL |
| 21/7 N. Juchors | 15€ X....= ........€ | 8€ X.....= .........€ | ..................€ | ||
| 21/7 J. Colom | 36€X.....= ........€ | 20€X.....= .........€ | 12€X.....= ........€ | ..................€ | |
| 22/7 S. Lavaud | 15€ X....= ........€ | 8€ X......= .........€ | ..................€ | ||
| 22/7 M. Y. Wu | 36€X.....= ........€ | 20€X.....= .........€ | 12€X.....= .........€ | ..................€ | |
| 23/7 V. Forte | 15€ X....= ........€ | 8€ X......= ........€ | ..................€ | ||
| 23/7 I. Schwindt | 36€X.....= .........€ | 20€X.....= .........€ | 12€X.....= ........€ | ..................€ | |
| 6 concerts | 100€X.....=........€ | ..................€ | |||
TOTAL à PAYER |
....................€ | ||||