Island Ecology

 ษiceolaํocht Oileแn

Cape Clear Island 5th - 9th July 2010

Oileแn Chl้ire 5๚ - 9๚ I๚il 2010

REGISTRATION FORM

FOIRM CHLมRAITHE

Costas an Ch๚rsa €200

Cost of the Course €200

Please return with € 50 deposit by 20th June to:

Cuir ้arlais €50 leis agus cuir roimh 20๚ Meitheamh chuig:

Comharchumann Chl้ire Teo, Oileแn Chl้ire, An Sciobairํn, Co. Chorcaํ.

AINM /NAME:…….………………………………………………………………….


SEOLADH /ADDRESS:………………………………………………………………

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GUTHมN/TELEPHONE:…………………………………………………………….


RอOMHPHOST / E-MAIL…………………………………………………………....


Bia speisialta, mํ-chumas, fadhb shlแinte/Special dietary requirements, disability, medical condition

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Approximate age group (please circle): Cuir ciorcal timpeall ar an aosghr๚pa /

20 – 40

40 – 60

60 +