Guest identity

ATTENTION:

If you have never filled this document before please fill all the items and your attach bank account information (IBAN and/or BIC code, sometimes also named SWIFT code).

The input fields in red, marked with an * are mandatory.

Name *

As shown on your passport or national ID

First Name *

As shown on your passport or national ID

Email *

Date of Birth *

Format dd/mm/yyyy

Place of birth  

If not in France indicate also the country

Telephone numbers *

Please write each number on a different line and clearly indicate which one is your cell phone

Home address - if not in France indicate the country *

Professional infos

Work place * Public Private Other

Employer or other details *  

Fonction, grade  

Not necessary if you do not work in France

Invitation

Name of the event you are invited for *

Name of the person in charge of the event *

Destination *

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Departure date * Time of departure *
Format dd/mm/yyyy

Departing from : * Work place Home Elsewhere

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Return date * Return time *
Format dd/mm/yyyy

Arriving at : * Workplace Home Elsewhere

Accommodation * Yes No

Hotel room paid by the UMR will be booked by the UMR.

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Transportation *

Plane  * oui Non

Train  * oui Non

Personal car  * oui Non

Rented car  * oui Non

Others  * oui Non

Other infos about your trip to Bordeaux or Bayonne *

Indicate here the time and place where you wish to leave from (train station, airport), train or flight number, frequent flyer number, etc ...

Managers receiving the form

Select your dedicated manager : *

 Helene Grenier-Gen

 Elodie Naminzo

 I don't know

If at least part of your expenses might require a refund from the UMR, please email your bank account information (IBAN and/or BIC code, sometimes also named SWIFT code).

Upload your bank account information : 

Thank you