Following your accommodation & membership request Please complete this form FORM FOLLOWING REQUEST FOR ACCOMMODATION DURING THE SCHOOL YEAR Civility * M.Mrs Surname * Name * personal email * VERY IMPORTANT: We will use this address to communicate essential information to you; You are solely responsible if you ignore them. Make sure you do not block receipt of our emails (spam filter). Date of birth * format : dd/mm/yyyy Nationality * personal number phone * Family Adress * Family Postal Code * Family Town* Family Country* CAUTION INFORMATION Civility * M.Mrs Surname * Name * Adress * Postal Code * Town * Country * personal caution e-mail * VERY IMPORTANTE : We will use this address to communicate essential information to you; you engage your sole responsibility if you ignore them. Make sure you do not block receipt of our emails (spam filter). personal caution number phone * MEMBERSHIP INFORMATION Your school * IMT-BSTSPAutres course followed upon your arrival at MAISEL 1 single checkbox IMT-BS-1A IMTBS-C1 IMT-BS-2A IMTBS-C2 IMT-BS-3A IMTBS-C3 IMT-BS-BACHELOR-1A IMTBS-BACH1 IMT-BS-BACHELOR-2A IMTBS-BACH2 IMT-BS-BACHELOR-3A IMTBS-BACH3 IMT-BS-STAGIAIRE ou IMT-BS-THESARD IMTBS-STATH TSP-1A TSP-C1 TSP-2A TSP-C2 TSP-3A TSP-C3 TSP-FISA-1A TSP-FISA1 TSP-FISA-2A TSP-FISA2 TSP-FISA-3A TSP-FISA3 TSP-STAGIAIRE ou TSP-THESARD TSP-STATH Autres Your arrival date* Aamong the opening days and hours of our offices : Monday to Thursday from 1:30 p.m. to 5:30 p.m. - Friday from 1:30 p.m. to 4:30 p.m. Attention ! This date cannot be modified, your first fee will be calculated from this date even if you arrive after format : dd/mm/yyyy Departure date : "BANK DETAILS" Country Code * (exemple : FR) Country Controle Code* (exemple : France = 76) Code BBAN * (exemple : establishment code + account + key) Code BIC *: Insert the 11 characters of your BIC or SWIFT CODE (letters and/or numbers) if less than 11 characters, add XXX at the end to reach 11"> Titular account name COMMITMENT *In the event of inaccurate information, admission may be refused; Admission is only effective after signing your membership contract. I certify on my honor the accuracy of the information communicated and to have read the Operating Charter of MAISEL SudParis. Δ