Mr./Mrs/Miss:
Address:
Telephone:
Work Tel:
Mobile:
Fax:
E-mail:
Other:

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Type of Yacht:	OCEANIS CLIPPER 473ODYSSEY 54DS
Base of Departure :
Base of Return :
Dates from :
To:
Days:

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Skipper

Hostess

Provisions

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Hotel:

On arrival

On departure

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Transfer:

On arrival

On departure

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No	First and Last Name	Nationality	Passport No or I.D.
1
2
3
4
5
6
7
8
9
10

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Skipper Name:
Type of License:
Co-Skipper Name:
Type of License:

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Date:

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