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Surame |
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Name |
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Adress 1 |
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Adress 2 |
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Zip code |
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City |
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Country |
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State |
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Your E-mail : |
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Age |
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Countries whitch interest you : |
A |
B |
C |
Type of your interest |
Socio (Teatching, Medical) / Cultural
(Ethnopharmacy) / Scientist
(Botanic,
Ecology) |
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Level comfort |
All comfort(3-4 stars) / Mixt( Medium comfort)
/ Tracking ( ... ) |
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Do you have relations? |
Local relations(Usefull to the groupe) /
Colleagues or Friends (Who would like participe this travel) |
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You can participe to prepare this travel : |
Files (History, Geography,
Botanic, Ethnopharmacology) Confernces
(Ethnopharmacology) Preparation of report
(Collection photographies,
documents, videos, ) Participation in the preparation in the CD-ROM
" Recollection " ( And Stake on Web of the
anecdotes of the Journey ) |
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Yours favorites dates |
January - February
Februaryr - March
March - April
April - May
May - June
June - July
July - August
August - September
September-October October - November November - December
December-January |
How many persons ? |
2 to 5 6 to 10 11 to 15 16 to 20 More 20 |
Yours preferences : |
Going
to
in
for
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Type yours comments |
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Thank
you
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