Cité de l'Espace

Group Cosmo-pass order form

Applicant’s name and first name *

Title / position

e-mail *

Name of organisation *

Organisation address *

Adresse de Facturation

Organisation telephone no. *

Mobile or personal telephone

Organisation fax

Customer code (option)

Type of group

1 adult entry: 18,50 € - Number of tickets *

1 child entry: 14,50 € - Number of tickets *

Total (minimum 20 tickets) - Postage cost: €6.50 *

Comments

* Compulsory information