Place du Jardin Public 64270 SALIES-DE-BEARN Tél : 05 59 38 10 11 - Fax : 05 59 38 05 84
Booking form
Treatment from   to
 Personal details
Maiden name
Date of birth
Social Security number (for residents in France)
Surname
First name
Address
Town
Postcode
Country
Telephone No.
Fax No.
Email
Person to contact if necessary :
 Prescribing doctor (home doctor)
Name
First name
Address
Postcode
Town
Country
Telephone No.
Fax No.
Email
 Spa doctor (Salies-de-Béarn)
Name
 Accommodation
SPA STUDIO APPARTMENTS   HOTEL   FURNISHED ROOM   CAMPING/CARAVAN    OTHER
Name
Address  
Telephone No.
 Times required and practical details
1st time period required :
7.00 - 8.30 a.m. 8.00 - 10.30 a.m. After 10.00 a.m.
2nd time period, by default (must be completed) :
7.00 - 8.00 a.m. After 10.00 a.m.
Do you need a wheelchair ? OUI NON
 Recommendation
A present will be offered to you for any new curist sent via you ...
Name
First name
Address
Postcode
Town
Country
Telephone No.
Fax No.
Email
Treatment from  to
Does the person recommended want to receive a booking form? YES

We would like to inform you that the new working hours do not take into
consideration any requests concerning the staff.

Comments
Your personal details are for the Salies-de-Béarn Thermal Baths. However, they can be sent to third parties (business partners, etc.).
If you do not want this, please tick the box

IMPORTANT: please read the booking sections

• SPA WATER TREATMENT OPENING PERIOD : From march 3rd to december 13th 2008 (included)